西那卡塞联合骨化三醇或帕立骨化醇治疗尿毒症甲状旁腺功能亢进的疗效

Effect of cinacalcet combined with calcitriol or paricalcitol in the treatment of uremia-induced secondary hyperparathyroidism

目的探讨西那卡塞分别联合骨化三醇、帕立骨化醇对尿毒症甲状旁腺功能亢进(SHPT)的疗效及对血管钙化的影响。方法选择142例尿毒症SHPT患者作为研究对象,用随机数字表法分为A组和B组,A组患者选择西那卡塞联合骨化三醇进行治疗,B组患者选择西那卡塞联合帕立骨化醇进行治疗,统计2组患者的疗效、治疗前后甲状旁腺大小、甲状腺功能及肾功能指标、血管钙化情况。结果142例患者中,共135例完成试验,A组67例,B组68例。A、B组治疗有效率分别为89.60%、91.18%,2组比较差异无统计学意义(P>0.05)。治疗12周,B组甲状旁腺长、宽和厚均显著小于A组(P<0.05)。治疗12周,B组血钙水平显著高于A组,血磷和全段甲状旁腺激素(iPTH)水平均显著低于A组(P<0.05)。治疗12周,B组冠状动脉钙化评分(CACS)和心脏瓣膜钙化率均显著低于A组(P<0.05)。A、B组不良反应发生率分别为7.46%、4.41%,2组比较差异无统计学意义(P>0.05)。结论西那卡塞联合帕立骨化醇对尿毒症SHPT患者的疗效优于骨化三醇,患者血磷、血钙和iPTH水平均得到显著改善,同时减少对血管钙化的影响。

Objective To explore the curative effect of cinacalcet respectively combined with calcitrol and paricalcitol on uremiainduced secondary hyperparathyroidism(SHPT)and their influences on vascular calcification.Methods A total of 142 patients with uremia-induced SHPT were enrolled and divided into group A and group B by random number table method.The patients in group A were given cinacalcet combined with calcitrol,while those in group B were given cinacalcet combined with paricalcitol.The curative effect,size of parathyroid glands,thyroid and renal function indexes,and vascular calcification before and after treatment in both groups were statistically analyzed.Results Of the 142 patients,there were 135 cases completing the test,including 67 cases in group A and 68 cases in group B.There was no significant difference in response rate of treatment between group A and group B(89.60%vs.91.18%)(P>0.05).After 12 weeks of treatment,the length,width and thickness of parathyroid glands in group B were significantly smaller than those in group A(P<0.05),the levels of blood calcium were significantly higher than that in group A,the levels of blood phosphorus and intact parathyroid hormone(iPTH)were significantly lower than those in group A(P<0.05),the coronary artery calcification score(CACS)and calcification rate of heart valve were significantly lower than those in group A(P<0.05).There was no significant difference in the incidence of adverse reactions between group A and group B(7.46%vs.4.41%)(P>0.05).Conclusion The curative effect of cinacalcet combined with paricalcitol is better than that of cinacalcet combined with calcitrol in patients with uremia-induced SHPT.The levels of blood phosphorus,blood calcium and iPTH are significantly improved,and the effects on vascular calcification are decreased.