不同骨化三醇给药方式对维持性血液透析SHPT患者iPTH及钙磷代谢水平的影响

Effects of Different Calcitriol Administration Methods on iPTH and Calcium and Phosphorus Metabolism Levels in SHPT Patients Undergoing Maintenance Hemodialysis

目的:探究不同骨化三醇给药方式对维持性血液透析(MHD)继发性甲状旁腺功能亢进症(SHPT)患者全段甲状旁腺激素(iPTH)及钙磷代谢水平的影响。方法:选取商丘市第一人民医院2019年9月至2020年12月期间收治并行MHD治疗的86例SHPT患者,随机分为对照组(43例,采用骨化三醇持续性小剂量给药治疗)和观察组(43例,采用骨化三醇间歇性大剂量给药治疗),将治疗时间划分为治疗前(T0)、治疗1个月后(T1)、治疗2个月后(T2)、治疗3个月后(T3)、治疗4个月后(T4)、治疗5个月后(T5)、治疗6个月后(T6);比较两组患者各个时间段iPTH、血钙、血磷水平,以及治疗期间药物不良反应发生情况。结果:T1~T6时两组患者的iPTH水平均较T0时下降,差异具有统计学意义(P<0.05);且两组患者T1~T6同时段iPTH水平比较,差异无统计学意义(P>0.05)。T1~T4时,两组患者的血钙、血磷水平与T0时比较,差异均无统计学意义(P>0.05);T5~T6时,对照组患者血钙、血磷水平均较T0时显著升高,差异具有统计学意义(P<0.05);T5~T6时,观察组患者血钙、血磷水平与T0比较,差异无统计学意义(P>0.05);T5~T6时,观察组患者的血钙、血磷水平显著低于对照组,差异具有统计学意义(P<0.05)。观察组患者的不良反应总发生率低于对照组,差异具有统计学意义(P<0.05)。结论:对接受MHD治疗的SHPT患者采用骨化三醇间歇性大剂量给药治疗相较于持续性小剂量给药更有利于控制钙磷代谢水平,预防高钙、高磷现象发生,且用药安全性较佳。

Objective To investigate the effects of different calcalitriol administration methods on intact parathyroid hormone(iPTH)and calcium and phosphorus metabolism in patients with secondary hyperparathyroidism(SHPT)undergoing maintenance hemodialysis(MHD).Methods A total of 86 SHPT patients who were admitted to Shangqiu First People's Hospital from September 2019 to December 2020 and treated with MHD were randomly divided into a control group(43 cases,treated with continuous low-dose calcitriol)and an observation group(43 cases,treated with intermittent high-dose calcitriol).The treatment time was divided into before treatment(T0),1 month after treatment(T1),2 months after treatment(T2),3 months after treatment(T3),4 months after treatment(T4),5 months after treatment(T5)and 6 months after treatment(T6);iPTH,blood calcium and blood phosphorus levels were compared between the two groups at each time period,and the incidence of adverse drug reactions during treatment period was compared between the two groups.Results The iPTH levels in both groups from T1 to T6 were decreased compared with those at T0,and the differences were statistically significant(P<0.05).There was no significant difference in iPTH levels between the the two groups at the same time from T1 to T6(P>0.05).From T1 to T4,blood calcium and phosphorus levels in the two groups were compared with those at T0,with no statistical significance(P>0.05).From T5 to T6,serum calcium and phosphorus levels in the control group were significantly higher than those at T0,with statistical significances(P<0.05).From T5 to T6,there was no statistical significance in serum calcium and phosphorus levels in the observation group compared with T0(P>0.05).From T5 to T6,serum calcium and phosphorus levels in the control group were significantly higher than those in the observation group,the differences were statistically significant(P<0.05).The total incidence of adverse reactions in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion Intermittent high-dose calcitriol administration for SHPT patients receiving MHD treatment is more beneficial to control calcium and phosphorus metabolism level and prevent the occurrence of high calcium and phosphorus,compared with continuous low-dose administration,with better medication safety.