碳酸镧联合骨化三醇冲击治疗血液透析合并继发性甲状旁腺功能亢进症的疗效及对钙磷的影响

The efficacy of lanthanum carbonate combined with calcitriol in the treatment of secondary hyperparathyroidism in hemodialysis and the effects on calcium and phosphorus

目的探讨碳酸镧联合骨化三醇治疗血液透析继发性甲状旁腺功能亢进症的疗效及对钙磷的影响。方法选取2017年1月至2019年10月于本院行维持性血液透析的30例继发性甲状旁腺功能亢进症(SHPT)患者作为研究对象,随机分为观察组与对照组,每组15例。观察组给予碳酸镧联合骨化三醇治疗,对照组给予碳酸钙联合骨化三醇治疗,比较两组治疗前后血钙、血磷、全段甲状旁腺激素(iPTH)水平、达标率及不良反应发生情况。结果两组iPTH组间、时间比较差异有统计学意义(P<0.05);组内比较:观察组治疗后各时间点iPTH均低于治疗前,且治疗12周低于治疗4、8周(P<0.05);治疗12周,对照组iPTH低于治疗前(P<0.05);组间比较:观察组治疗后各时间点iPTH均低于对照组(P<0.05)。两组血磷时间、组间比较差异有统计学意义(P<0.05);组内比较:观察组治疗后各时间点血磷均低于治疗前,且治疗8、12周均低于治疗4周(P<0.05);治疗12周,对照组血磷低于治疗前(P<0.05);组间比较:观察组治疗后各时间点低于对照组(P<0.05)。两组血钙时间、交互比较差异有统计学意义(P<0.05);组内比较:治疗8、12周,观察组血钙高于治疗前(P<0.05),对照组治疗后各时间点均高于治疗前(P<0.05);组间比较:治疗12周,观察组血钙低于对照组(P<0.05)。治疗12周,观察组iPTH达标率高于对照组(P<0.05),两组血磷、血钙达标率比较差异无统计学意义。两组不良反应发生率比较差异无统计学意义。结论碳酸镧联合骨化三醇可有效治疗血液透析继发性甲状旁腺功能亢进,降低血磷水平,且升高血钙,值得临床推广应用。

Objective To analyze the efficacy of lanthanum carbonate combined with calcitriol in the treatment of secondary hyperparathyroidism in hemodialysis and the effects on calcium and phosphorus.Methods 30 patients with secondary hyperparathyroidism(SHPT)who received maintenance hemodialysis in our hospital from January 2017 to October 2019 were selected as research subjects,and they were randomly divided into the observation group and the control group,with 15 cases in each group.The observation group was treated with lanthanum carbonate combined with calcitriol,and the control group was treated with calcium carbonate combined with calcitriol.The levels of blood calcium,blood phosphorus,whole parathyroid hormone(iPTH),the final standard rate of iPTH before and after treatment and the occurrence of adverse reactions were compared between the two groups.Results There were significant differences in iPTH inter-group and time of the two groups(P<0.05);intra-group comparison:iPTH in observation group was lower at all time points after treatment than before treatment,and at 12 weeks after treatment was lower than at 4 and 8 weeks after treatment(P<0.05);after 12 weeks of treatment,iPTH in control group was lower than before treatment(P<0.05);inter-group comparison:iPTH of observation group was lower than control group at all time points after treatment(P<0.05).There were statistically significant differences in blood phosphorus inter-group and time the two groups(P<0.05);intra-group comparison:blood phosphorus in observation group was lower at all time points after treatment than before treatment,and at 8 and 12 weeks after treatment was lower than at 4 weeks(P<0.05);after 12 weeks of treatment,blood phosphorus in control group was lower than that before treatment(P<0.05);inter-group comparison:the observation group was lower than the control group at each time point after treatment(P<0.05).There were statistically significant differences in blood calcium at time and interaction between the two groups(P<0.05);intra-group comparison:at 8 and 12 weeks of treatment,blood calcium in the observation group was higher than before treatment(P<0.05),while that in the control group was higher at all time points after treatment(P<0.05);inter-group comparison:after 12 weeks of treatment,blood calcium in observation group was lower than that in control group(P<0.05).After 12 weeks of treatment,the iPTH compliance rate of the observation group was higher than that of the control group(P<0.05),and there was no statistical significance in the compliance rates of blood phosphorus and blood calcium between the two groups.There was no significant difference in the incidence of adverse reactions between the two groups(P<0.05).Conclusion Lanthanum carbonate combined with calcitriol can effectively treat secondary hyperparathyroidism in hemodialysis,can reduce blood phosphorus levels and increase blood calcium,it is worthy of clinical application.