维生素D联合西那卡塞对长期血液透析患者继发性甲状旁腺功能亢进的应用效果

Effects of Vitamin D Combined with Cinacalcet on Secondary Hyperparathyroidism in Long-Term Hemodialysis Patients

目的 分析使用活性维生素D药物联合西那卡塞对长期血液透析患者继发性甲状旁腺功能亢进(SHPT)的应用效果。方法 选取2019年2月至2022年2月河南省直第三人民医院收治的110例长期血液透析患者SHPT进行研究。将上述110例患者采用简单随机分组法分为对照组(55例)和观察组(55例),对照组患者接受活性维生素D类药物骨化三醇治疗,观察组患者接受骨化三醇联合西那卡塞联合治疗。比较两组患者治疗前后的治疗有效率、生化指标[甲状旁腺激素(iPTH)、血清钙(血Ca^(2+))、血清无机磷(血P^(3-))、钙磷乘积]、肾功能指标[血尿素氮(BUN)、血肌酐(SCR)]、甲状旁腺体积以及不良反应。结果 治疗后,观察组患者治疗有效率(89.09%)高于对照组(72.73%)(P<0.05);两组患者的iPTH下降,且观察组低于对照组,差异有统计学意义(P<0.05);观察组的血Ca^(2+)水平上升,血P^(3-)水平下降,对照组血Ca^(2+)、血P^(3-)均上升,差异有统计学意义(P<0.05);两组患者的钙磷乘积均上升,且观察组低于对照组,差异有统计学意义(P<0.05);两组患者的肾功能指标较治疗前差异无统计学意义(P>0.05);两组患者的甲状旁腺体积均下降,差异有统计学意义(P<0.05);观察组患者不良反应率与对照组比较,差异无统计学意义(P>0.05)。结论 维生素D联合西那卡塞对长期血液透析患者SHPT效果显著,可改善钙磷代谢水平,减小甲状旁腺体积,且安全性良好。

Objective To analyze the effects of vitamin D combined with cinacalcet on secondary hyperparathyroidism(SHPT)in long-term hemodialysis patients.Methods A total of 110 long-term hemodialysis patients with SHPT were enrolled from February 2019 to February 2022 in Henan Provincial Third People’s Hospital.According to simple random grouping method,they were divided into control group(55 cases)and observation group(55 cases).The control group was treated with cinacalcet,while observation group was additionally treated with cinacalcet.The response rate of treatment,biochemical indexes[intact parathyroid hormone(iPTH),serum calcium(Ca^(2+)),serum inorganic phosphorus(P^(3-)),calcium-phosphorus product],renal function indexes[blood urea nitrogen(BUN),serum creatinine(SCR)],parathyroid volume and adverse reactions were compared between the two groups before and after treatment.Results After treatment,the effective rate in observation group(89.09%)was higher than that in control group(72.73%)(P<0.05).iPTH was decreased in both groups,which were lower in observation group than those in the control group(P<0.05).Level of serum Ca^(2+)was increased,serum P^(3-)was decreased in observation group,and levels of serum Ca^(2+),P^(3-)were decreased in observation group(P<0.05).Calcium-phosphorus product were increased in both groups,which were lower in observation group than those in the control group(P<0.05).There was no significant change of renal function indexes in the two groups before and after treatment(P>0.05).After treatment,parathyroid volume was decreased in both groups,and there were significant differences between the two groups(P<0.05).There was no significant difference in the incidence of adverse reactions between observation group and control group(P>0.05).Conclusion Curative effect of vitamin D combined with cinacalcet is significant in patients with long-term hemodialysis and SHPT,which can improve calcium-phosphorus metabolism and reduce parathyroid volume,with good safety.