继发性甲状旁腺功能亢进患者药物和手术治疗的疗效及经济效果的比较

Cost-effect analysis of surgical and medical treatment for patients of secondary hyperparathybridism

目的探讨继发性甲状旁腺功能亢进患者药物治疗和甲状旁腺切除手术的疗效与经济效果的关系。方法收集2011至2020年成都市第三人民医院收治的60例继发性甲状旁腺功能亢进患者,采用随机数字表法分为西那卡塞组、阿法骨化醇组和手术组,每组20例。结果治疗后手术组的骨痛和皮肤瘙痒改善优于西那卡塞组和阿法骨化醇组(χ^(2)=16.282,P<0.001;χ^(2)=12.823,P=0.002)。治疗12个月,手术组和西那卡塞组血清甲状旁腺激素(iPTH)低于阿法骨化醇组(HR=1.36,95%CI:1.00~1.72,P<0.001;HR=1.27,95%CI:0.91~1.63,P<0.001),手术组血钙低于西那卡塞组和阿法骨化醇组(HR=0.18,95%CI:0.12~0.24,P<0.001;HR=0.14,95%CI:0.08~0.20,P<0.001)。手术组的并发症费用低于西那卡塞组和阿法骨化醇组(H=40.534,P<0.001),有骨痛患者的并发症费用高于无骨痛患者(H=38.494,P<0.001),血清iPTH>2800 pg/ml患者的治疗费用高于血清iPTH 800~1800/ml者和血清iPTH 1800~2800/ml者(H=43.798、37.260,P<0.001)。结论手术治疗应该作为继发性甲状旁腺功能亢进患者的首选治疗方式,尤其是对血清iPTH>2800 pg/ml和骨痛的患者。

Objective To explore the cost-effectiveness of alfacalcidol and cinacalcet for the treatment of secondary hyperparathyroidism in dialysis patients compared with parathyroidectomy.Methods A total of 60 patients with secondary hyperparathyroidism treated at the Third People's Hospital of Chengdu from 2011 to 2020 were studied,patients were randomly divided into three groups:cinacalcet group,alfacalcidol group and parathyroidectomy group,with 20 cases in each group.Result The improvement rate of bone pain and skin pruritis in parathyroidectomy group were higher than that in cinacalcet group and alfacalcidol group(χ^(2)=16.282,P<0.001;χ^(2)=12.823,P=0.002).After 12 months of treatment,iPTH in the parathyroidectomy group and the cinacalcet group was significantly lower than that in the alfacalcidol group(HR=1.36,95%CI:1.00-1.72,P<0.001;HR=1.27,95%CI:0.91-1.63,P<0.001);Serum calcium in the parathyroidectomy group was significantly lower than that of the other two groups(HR=0.18,95%CI:0.12-0.24,P<0.001;HR=0.14,95%CI:0.08-0.20,P<0.001).The cost of complications management in the parathyroidectomy group was the lowest(H=40.534,P<0.001),with bone pain being the most cost concern(H=38.494,P<0.001).Patients with iPTH>2800 pg/ml had the highest costs than with 800~1800/ml and 1800~2800/ml(H=43.798,37.260,P<0.001).Conclusion Surgical treatment should be the first choice for patients with secondary hyperparathyroidism,especially for patients with iPTH>2800 pg/ml and bone pain.