西那卡塞治疗维持性血液透析伴继发性中重度甲状旁腺功能亢进患者疗效及对血清CKMB、cTnT、MYO水平的影响

Curative effect of cinacalcet and its influences on serum CKMB,cTnT and MYO in patients with moderate to severe secondary hyperparathyroidism after maintenance hemodialysis

目的观察西那卡塞治疗维持性血液透析(MHD)伴继发性中重度甲状旁腺功能亢进(MS-SHPT)患者的临床疗效及患者血清肌酸激酶同工酶(CKMB)、心肌肌钙蛋白T(cTnT)、肌红蛋白(MYO)水平的变化情况。方法选取2021年1月~2022年9月舒城县人民医院收治的200例MHD-MSSHPT患者,随机数表法将患者分为观察组(n=100,常规治疗联合西那卡塞治疗法)与对照组(n=100,常规治疗法),治疗周期均为12周。于治疗前、治疗6和12周后,分别检测患者甲状旁腺功能[血清钙(Ca)、磷(P)、钙磷乘积(Ca×P)、全段甲状旁腺素(iPTH)]及心血管功能(血清CKMB、cTnT、MYO)实验室指标水平,观察治疗期间不良反应情况。结果治疗后,两组患者的血清Ca、P、Ca×P及iPTH水平均较治疗前降低,且观察组治疗后6和12周后的上述指标水平均低于对照组,差异有统计学意义(P<0.05)。治疗后,两组患者的血清CKMB、cTnT、MYO水平均较治疗前降低,且观察组治疗12周后的上述指标水平均低于对照组,差异有统计学意义(P<0.05)。观察组的总不良反应发生率为15.00%,与对照组的10.00%比较,差异无统计学意义(P>0.05)。结论对MHD-MSSHPT患者采用西那卡塞治疗可有效降低iPTH水平,维持钙磷代谢稳态,保护心血管功能,提高临床疗效,且具有较好的安全性。

Objective To observe the clinical curative effect of cinacalcet and the changes of serum creatine kinase MB(CKMB),cardiac troponin T(cTnT)and myohemoglobin(MYO)in patients with moderate to severe secondary hyperparathyroidism(MS-SHPT)after maintenance hemodialysis(MHD).Methods A total of 200 patients with MDD-MSSHPT admitted to the Shucheng People’s hospital were enrolled and randomly divided into observation group(n=100,routine therapy combined with cinacalcet)and control group(n=100,routine therapy)between January 2021 and September 2022.All were treated for 12 weeks.Before treatment,after 6 and 12 weeks after treatment,levels of parathyroid function indexes[serum calcium(Ca),phosphorus(P),calcium-phosphorus product(Ca×P),intact parathyroid hormone(iPTH)]and cardiovascular function indexes(CKMB,cTnT,MYO)were detected.The adverse reactions during treatment were observed.Results After treatment,the serum levels of Ca,P,Ca×P,and iPTH in both groups decreased compared to before treatment,and the levels of these indicators in the observation group at 6 and 12 weeks after treatment were lower than those in the control group,with statistical significance(P<0.05).After treatment,the serum levels of CKMB,cTnT,and MYO in both groups decreased compared to before treatment,and the levels of these indicators in the observation group at 12 weeks after treatment were lower than those in the control group,with statistical significance(P<0.05).The total incidence of adverse reactions in the observation group was 15.00%,which was not statistically different from the 10.00%in the control group(P>0.05).Conclusion Cinacalcet can effectively reduce iPTH level,maintain steady state of calcium-phosphorus metabolism,protect cardiovascular function and improve clinical curative effect in MHD-MSSHPT patients,with good safety.