碳酸镧对腹膜透析合并继发性甲状旁腺功能亢进患者动脉钙化的临床研究

Research of lanthanum carbonate on arterial calcification in peritoneal dialysis patients with secondary hyperparathyroidism

目的研究碳酸镧对维持性腹膜透析合并继发性甲状旁腺功能亢进患者动脉钙化的疗效。方法将80例腹膜透析合并继发性甲状旁腺功能亢进患者作为研究对象,随机分为对照组和试验组,2组各40例。对照组给予常规治疗+骨化三醇口服治疗,试验组在对照组的基础上加用碳酸镧口服治疗。比较2组血清全段甲状旁腺激素(iPTH)、血清肌腱蛋白-C(TN-C)水平,甲状旁腺大小、冠状动脉钙化(CAC)积分,钙、磷和钙磷乘积水平,药物不良反应发生情况。结果治疗后,对照组和试验组的血钙水平分别为(2.30±0.15)和(1.98±0.20)mmol·L^(-1);这2组的血磷水平分别为(1.75±0.23)和(1.67±0.20)mmol·L^(-1);这2组的钙磷乘积水平分别为(4.02±0.56)和(3.34±0.56)mmol·L^(-1);这2组的iPTH水平分别为(570.59±101.57)和(368.90±86.63)pg·mL^(-1);这2组的TN-C水平分别为(63.66±5.15)和(56.48±5.66)μg·L^(-1);这2组的甲状旁腺体积(长、宽、高)分别为(8.25±0.54),(4.63±0.49),(3.63±0.49)mm和(6.43±0.55),(3.75±5.43),(2.75±0.44)mm;这2组治疗6个月后CAC积分分别为(490.19±34.03)和(455.45±28.25)分。上述指标,试验组各项指标均优于对照组,差异均有统计学意义(均P<0.05)。试验组和对照组的药物不良反应发生率分别为7.50%和15.00%,差异无统计学意义(P>0.05)。结论碳酸镧可下调腹膜透析合并继发性甲状旁腺功能亢进患者降低血清甲状旁腺激素、TN-C水平,缓解甲状旁腺功能亢进,减轻患者冠状动脉钙化。

Objective To study the effect of lanthanum carbonate on arterial calcification in patients with maintenance peritoneal dialysis complicated with secondary hyperparathyroidism.Methods A total of 80 patients with peritoneal dialysis combined with secondary hyperparathyroidism were selected as the research objects,and they were randomly divided into two groups,the control group and the treatment group,with 40 cases in each group.The control group was given conventional treatment+calcitriol oral treatment,and the treatment group was additionally given lanthanum carbonate oral treatment on the basis of the control group.Comparing the two groups,serum full-segment parathyroid hormone(iPTH),tenascin-C(TN-C)levels,parathyroid gland size,coronary artery calcification(CAC)score,calcium,phosphorus and calcium-phosphorus product levels,adverse drug incidence.Results After treatment,the blood calcium levels of the control group and the treatment group were(2.30±0.15)and(1.98±0.20)mmol·L^(-1),respectively;the blood phosphorus levels of the two groups were(1.75±0.23)and(1.67±0.20)mmol·L^(-1);the calcium and phosphorus product levels of the two groups were(4.02±0.57)and(3.34±0.56)mmol·L^(-1);the iPTH levels of the two groups were(570.59±101.59)and(368.90±86.63)pg·mL^(-1);the TN-C levels of these two groups were(63.66±5.15)and(56.48±5.66)μg·L^(-1),respectively;the parathyroid gland volumes(length,width,height)of the two groups were(8.25±0.54),(4.63±0.49),(3.63±0.49)mm and(6.43±0.55),(3.75±5.43),(2.75±0.44)mm;CAC in the two groups after 6 months of treatment were(490.19±34.03)and(455.45±28.25)scores respectively.All indicators in the treatment group were better than those in the control group,and the differences were statistically significant(all P<0.05).The incidences of adverse drug reactions in the treatment group and the control group were 7.50%and 15.00%,respectively,and the difference was not statistically significant(P>0.05).Conclusion Lanthanum carbonate can down regulate the levels of serum parathyroid hormone and tenascin-C(TN-C)in peritoneal dialysis patients with secondary hyperparathyroidism,alleviate hyperparathyroidism and coronary artery calcification.