司维拉姆、西那卡塞分别联合骨化三醇治疗MHD伴SHPT的临床效果

Clinical effect of sevelamer and cinacalcet combined with calcitriol in the treatment of MHD with SHPT

目的探讨司维拉姆、西那卡塞分别联合骨化三醇在维持性血液透析(MHD)伴甲状旁腺功能亢进(SHPT)治疗中的应用效果。方法74例MHD伴SHPT患者,依据平行对照法分为对照组及观察组,每组37例。对照组采用司维拉姆联合骨化三醇治疗,观察组采用西那卡塞联合骨化三醇治疗。比较两组治疗效果、甲状腺功能及不良反应发生情况。结果观察组治疗总有效率94.59%高于对照组的75.68%,差异有统计学意义(χ^(2)=5.232,P=0.022<0.05)。治疗后,观察组碱性磷酸酶(ALP)(71.52±19.81)U/L低于对照组的(118.96±19.94)U/L,血钙(2.63±0.10)mmol/L和血磷(1.57±0.02)mmol/L高于对照组的(2.23±0.09)、(1.28±0.03)mmol/L,差异有统计学意义(P<0.05)。观察组不良反应发生率8.11%(3/37)低于对照组的13.51%(5/37),但差异无统计学意义(χ^(2)=0.561,P=0.454>0.05)。结论西那卡塞联合骨化三醇治疗MHD伴SHPT效果优于司维拉姆联合骨化三醇,不仅能够改善甲状腺功能,而且安全性高,值得临床应用与推广。

Objective To discuss the application effect of sevelamer and cinacalcet combined with calcitriol in the treatment of maintenance hemodialysis(MHD)with secondary hyperparathyroidism(SHPT).Methods A total of 74 patients with MHD and SHPT were divided into control group and observation group according to the parallel control method,with 37 cases in each group.The control group was treated with sevelamer and calcitriol,and the observation group was treated with cinacalcet and calcitriol.The therapeutic effect,thyroid function and the occurrence of adverse reactions were compared between the two groups.Results The total effective rate of treatment 94.59%in the observation group was higher than 75.68%in the control group,and the difference was statistically significant(χ^(2)=5.232,P=0.022<0.05).After treatment,the alkaline phosphatase(ALP)(71.52±19.81)U/L of the observation group was lower than(118.96±19.94)U/L of the control group,and the blood calcium(2.63±0.10)mmol/L and blood phosphorus(1.57±0.02)mmol/L were higher than(2.23±0.09)and(1.28±0.03)mmol/L of the control group.All the differences were statistically significant(P<0.05).The incidence of adverse reactions 8.11%(3/37)in the observation group was lower than 13.51%(5/37)in the control group,but the difference was not statistically significant(χ^(2)=0.561,P=0.454>0.05).Conclusion Cinacalcet combined with calcitriol is more effective than sevelamer combined with alcitriol in the treatment of MHD with SHPT,and it can improve the thyroid function with high safety,which is worthy of clinical application and promotion.