帕立骨化醇联合血液灌流治疗血液透析患者继发性甲状旁腺功能亢进症的疗效

The efficacy of paricalcitol combined with hemoperfusion on secondary hyperparathyroidism in hemodialysis patients

目的观察帕立骨化醇联合血液灌流治疗血液透析患者继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)的疗效。方法将入组的30例患者随机分为A组(帕立骨化醇组)和B组(帕立骨化醇+血液灌流组),所有病例随访12周。患者治疗前、4周、8周、12周分别复查相关生化指标;每2周监测钙、磷、全段甲状旁腺激素(intact parathyroid hormone,iPTH)。结果①和治疗前比较,2组iPTH、碱性磷酸酶在4周后均下降(A组t=6.048,3.459;P<0.001,0.004;B组t=6.776,3.366;P<0.001,0.005)。和A组比较,治疗8周时B组帕立骨化醇剂量减少(t=3.298,P=0.003),甲状旁腺激素和碱性磷酸酶水平下降更明显(t=2.635,2.508;P=0.014,0.018)。②iPTH下降>30%的例数在4周、8周、12周A组分别为4、7、10例,B组分别为6、11、12例。③和治疗前比较,B组血磷和钙磷乘积4周后均下降(t=19.176,4.801;P均<0.001),2组血钙在2周后均升高(A组:t=2.926,P=0.011;B组t=2.756,P=0.015)。和A组比较,B组4周后血磷和钙磷乘积降低(t=3.889,3.510;P=0.001,0.002)。结论帕立骨化醇治疗可有效降低SHPT透析患者的iPTH水平,联合血液灌流治疗效果更佳,且可降低血磷和钙磷乘积及减少帕立骨化醇剂量。

Objectives To observe the efficacy of paricalcitol combined with hemoperfusion on secondary hyperparathyroidism(SHPT)in maintenance hemodialysis(MHD)patients.Methods Thirty MHD patients with SHPT were randomly divided into group A(treated with paricalcitol)and group B(treated with paricalcitol plus hemoperfusion).They were followed up for 12 weeks.During the 12 weeks treatment period,biochemical markers were assayed at baseline and every 4 weeks,and serum intact parathyroid hormone(iPTH),calcium,phosphorus and alkaline phosphatase(ALP)were assayed every 2 weeks.The efficacy parameter was set at the decrease of iPTH more than 30%of baseline value after 12 weeks treatment.The incidence of adverse events was also observed.Results①Compared to the baseline levels,serum iPTH and ALP were significantly declined after the treatment for 4 weeks in both groups(in group A:t=6.048 and3.459,P<0.001 and 0.004;in group B:t=6.776 and 3.366,P<0.001 and 0.005).After the treatment for 8 weeks,paricalcitol dosage,serum iPTH and serum ALP were markedly declined in group B than in group A(t=3.298,2.635 and 2.508,P=0.003,0.014 and 0.018).②After the treatment for 12 weeks,the number of patients with the decrease of iPTH more than 30%of the baseline value were 10 in group A and 12 in group B.③Compared with the baseline values,serum phosphorus and calcium-phosphorus product were markedly declined after the treatment for 4 weeks in group B(t=19.176 and 4.801,P<0.001),and serum calcium was higher after the treatment for 2 weeks in both groups(group A:t=2.926,P=0.011;group B:t=2.756,P=0.015).After the treatment for 4 weeks,serum phosphorus and calcium-phosphorus product were apparently lower in group B than in group A(t=3.889 and 3.510,P=0.001 and 0.002).Conclusions Paricalcitol therapy is effective for lowering serum iPTH in MHD patients with SHPT;paricalcitol combined with hemoperfusion will have better effects in lowering paricalcitol dosage,serum phosphorus and calcium-phosphorus product.