西那卡塞联合骨化三醇治疗糖尿病肾病血液透析患者继发性甲状旁腺功能亢进症的效果

Effect of cinacalcet combined with calcitriol on secondary hyperparathyroidism in patients undergoing hemodialysis for diabetic nephropathy

目的研究西那卡塞联合骨化三醇治疗糖尿病肾病(DN)血液透析患者继发性甲状旁腺功能亢进症(SHPT)的效果。方法队列研究。抽取2020年1月至2022年12月漯河市第一人民医院收治的DN血液透析合并SHPT患者92例,按随机数字表法分为单一用药组和联合用药组,每组46例。单一用药组采用西那卡塞治疗,联合用药组采用西那卡塞联合骨化三醇治疗。比较两组疗效、钙磷代谢指标、血清全段甲状旁腺激素(iPTH)和甲状旁腺体积、甲状腺激素[促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)]水平及不良反应。结果联合用药组总有效率(93.48%,43/46)高于单一用药组(76.09%,35/46),P<0.05。治疗后,联合用药组血钙高于单一用药组,血磷低于单一用药组(P<0.05)。联合用药组iPTH、甲状旁腺体积低于单一用药组(P<0.05);联合用药组TSH、FT3、FT4低于单一用药组(P<0.05)。联合用药组不良反应(10.87%,5/46)与单一用药组(6.52%,3/46)比较差异未见统计学意义(P>0.05)。结论DN血液透析合并SHPT患者应用西那卡塞联合骨化三醇治疗的效果显著,能改善钙磷代谢和甲状腺功能,且联合用药不会增加不良反应的发生。

ObjectiveTo study the effect of cinacalcet combined with calcitriol on secondary hyperparathyroidism(SHPT)in patients undergoing hemodialysis for diabetic nephropathy(DN).MethodsNinety-two patients who underwent hemodialysis for DN complicated by SHPT in Luohe First People’s Hospital from January 2020 to December 2022 were selected for the cohort study.And they were divided into single drug group and combined drug group according to random number table method,with 46 cases in each group.The single drug group was treated with cinacalcet,and the combined drug group was treated with cinacalcet combined with calcitriol.The therapeutic effect,calcium and phosphorus metabolism indexes,serum intact parathyroid hormone(iPTH)and parathyroid volume,levels of thyroid hormones including thyroid stimulating hormone(TSH),free triiodothyronine(FT3)and free thyroxine(FT4),and incidence of adverse reactions were compared between the two groups.ResultsThe total effective rate of the combined drug group(93.48%,43/46)was higher than that of the single drug group(76.09%,35/46),P<0.05.After treatment,the combined drug group had higher level of serum calcium and lower level of serum phosphorus compared with the single drug group(P<0.05).The levels of iPTH and parathyroid volume in the combined drug group were lower than those in the single drug group(P<0.05).Levels of TSH,FT3 and FT4 in the combined drug group were lower than those in single drug group(P<0.05).There were significant differences in the incidence of adverse reactions between the combined drug group(10.87%,5/46)and the single drug group(6.52%,3/46),P>0.05.ConclusionsIn DN hemodialysis patients with SHPT,cinacalcet combined with calcitriol has a significant therapeutic effect,which can improve calcium and phosphorus metabolism and thyroid function without increase in the occurrence of adverse reactions.