帕立骨化醇对血液透析患者甲状旁腺激素和冠状动脉钙化及左心室肥厚进展的影响研究

Effect of paricalcitol on parathyroid hormone and coronary calcification and left ventricular hypertrophy progression in hemodialysis patients

目的观察帕立骨化醇(Pc)对维持性血液透析(MHD)患者全段甲状旁腺激素(iPTH)及冠状动脉钙化和左心室肥厚进展的影响。方法纳入2020年8月1日至30日于首都医科大学附属北京安贞医院行MHD的西那卡塞治疗疗效不佳的难治性继发性甲状旁腺机能亢进症(SHPT)患者37例,采用随机数字表法随机分为Pc组(18例)和Pc联合西那卡塞组(19例),在转化或加用Pc治疗后,观察血钙(Ca)、血磷(P)、碱性磷酸酶(ALP)、iPTH、冠状动脉钙化积分(CACs)和左心室重量指数(LVMI)的变化。结果与基线相比,Pc治疗第3、6及12个月时Ca、iPTH和ALP均有显著变化,差异有统计学意义(P<0.05);Pc治疗第3、6和12个月时血P与基线相比较差异均无统计学意义(P>0.05)。Pc组或Pc联合西那卡塞组治疗第3、6和12个月时ΔiPTH、ΔCa、ΔP和ΔALP差异无统计学意义(P>0.05)。所有患者在治疗12个月后,与基线相比较,CACs和LVMI均显著升高,差异有统计学意义(P<0.05),比较Pc组和Pc联合西那卡塞组患者ΔCACs和ΔLVMI差异无统计学意义(P>0.05)。结论Pc可以有效控制MHD患者难治性SHPT,升高血钙、磷作用小,对于冠状动脉钙化和左心室肥厚进展的作用有待进一步验证。

Objective To observe the effect of paricalcitol(Pc)on the progression of total parathyroid hormone(iPTH),coronary calcification and left ventricular hypertrophy in patients with maintenance hemodialysis(MHD).Methods In August 2020,37 patients with refractory secondary hyperparathyroidism(SHPT)who responded poorly to Sinacasse therapy were screened in the hemodialysis center of Beijing Anzhen Hospital.These patients were divided into Pc group(n=18)and Pc combined with Sinacasse group(n=19).The changes in calcium(Ca),phosphorus(P),alkaline phosphatase(ALP),iPTH,coronary calcification integral(CACs)and left ventricular weight index(LVMI)were observed after conversion or addition of Pc treatment.Results Ca,iPTH and ALP were statistically different at the 3rd month of Pc treatment compared to baseline,and the differences were still statistically significant at 6 and 12 months of treatment compared with baseline.There was no statistically significant difference in P compared with baseline at 3,6,and 12 months of Pc treatment(P>0.05).There was no statistical difference inΔiPTH at the 3rd month of Pc alone or in combination with Sinacasse,andΔCa,ΔP,orΔALP at the 3rd,6th and 12th months of treatment(P>0.05).After 12 months of treatment,CACs and LVMI were statistically higher compared with baseline in 37 patients(P<0.05),but there was no statistical difference in comparingΔCACs andΔLVMI between the two groups.Conclusion Pc can effectively control refractory SHPT in patients with MHD,the effect of increasing blood calcium and phosphorus is small,and the effect on coronary calcification and left ventricular hypertrophy progression needs to be further verified.