骨化三醇治疗维持性血液透析肾衰竭患者对高转运骨营养不良的影响及安全性分析

The analysis on the effect and safety of calcitriol on high turnover osteodystrophy in the treatment of patients with maintenance hemodialysis renal failure

目的探讨骨化三醇治疗维持性血液透析肾衰竭患者对高转运骨营养不良的影响及安全性。方法选择绍兴市中心医院医共体总院2018年4月至2020年6月诊治的80例维持性血液透析肾衰竭患者为研究对象,采用随机数字表法分为对照组和观察组,每组40例。对照组给予口服钙制剂治疗,观察组在对照组基础上给予骨化三醇注射液治疗,共治疗3个月。比较两组的疗效及治疗期间不良反应发生率;比较两组治疗前后骨代谢相关指标、肾功能指标、炎性因子、红细胞压积(Hct)及血红蛋白(Hb)水平的变化情况。结果观察组治疗后总有效率高于对照组[95.0%(38/40)比80.0%(32/40)],差异有统计学意义(χ^(2)=4.11,P<0.05)。观察组治疗后免疫反应性甲状旁腺激素、血磷及骨碱性磷酸酶水平低于对照组[(391.74±28.69)ng/L比(468.50±30.52)、(1.02±0.16)mmol/L比(1.63±0.21)mmol/L、(70.59±4.15)U/L比(73.64±4.09)U/L],血钙水平高于对照组[(2.05±0.13)mmol/L比(1.93±0.11)mmol/L],差异均有统计学意义(P<0.05)。两组治疗后血清肌酐、尿素氮、白蛋白水平及治疗期间不良反应发生率比较差异无统计学意义(P>0.05)。结论对维持性血液透析肾衰竭患者给予骨化三醇治疗,可改善高转运骨营养不良及贫血状态,且安全性较高。

Objective To investigate the effect and safety of calcitriol on high turnover osteodystrophy in the treatment of patients with maintenance hemodialysis renal failure.Methods Eighty patients with maintenance hemodialysis renal failure from April 2018 to June 2020 were selected as study objects and divided into the control group(40 cases)and the observation group(40 cases)by the random number table method.The control group was treated with oral calcium carbonate and other oral calcium preparations.The observation group was additively treated with calcitriol on the basis of the control group for 3 months.The therapeutic efficacy and the incidence of adverse reactions during the treatment were compared between the two groups;the levels of bone metabolism related index,kidney function index,hematocrit(Hct)and hemoglobin(Hb)and other index were compared between the two groups before and after treatment.Results The total effective rate of the observation group was higher than that of the control group:95.0%(38/40)vs.80.0%(32/40),the difference was statistically significant(χ^(2)=4.11,P<0.05).After treatment,the levels of immune reactivity parathyroid hormone(iPTH),serum phosphorus,bone alkaline phosphatase(BALP)in the observation group were lower than those in the control group:(391.74±28.69)ng/L vs.(468.50±30.52),(1.02±0.16)mmol/L vs.(1.63±0.21)mmol/L,(70.59±4.15)U/L vs.(73.64±4.09)U/L,and the level of serum calcium was higher than that in the control group:[(2.05±0.13)mmol/L vs.(1.93±0.11)mmol/L,the differences were statistically significant(P<0.05).After the treatment,the levels of serum creatinine(SCr),blood urea nitrogen(BUN),serum albumin(ALB)and the incidence of adverse reactions between the two groups had no significant differences(P>0.05).Conclusions The administration of calcitriol in the treatment of patients with maintenance hemodialysis renal failure can improve the status of high turnover osteodystrophy and anemia,and has a high safety.