骨化三醇冲击治疗联合甲状旁腺全切术对肾衰竭继发性甲状旁腺功能亢进患者疗效及钙磷代谢的影响

Effect of Calcitriol Shock Therapy Combined with Total Parathyroidectomy on the Efficacy and Calcium and Phosphorus Metabolism in Renal Failure Patients with Secondary Hyperparathyroidism

目的 探讨骨化三醇冲击治疗联合甲状旁腺全切术对肾衰竭继发性甲状旁腺功能亢进患者疗效、钙磷代谢的影响,并观察药物治疗安全性。方法 选取2020年1月至2022年9月收治的90例肾衰竭继发性甲状旁腺功能亢进患者,采用随机数字表法分为观察组和对照组各45例。对照组接受甲状旁腺全切术治疗,观察组在对照组基础上加用骨化三醇冲击治疗。比较2组患者总有效率,治疗前后钙磷代谢指标、炎症指标、营养状态指标、血红蛋白水平及促红细胞生成素(EPO)用量和安全性。结果 观察组治疗后总有效率为93.33%显著高于对照组的77.78%(P<0.05)。治疗后6、12个月2组血清全段甲状旁腺激素(iPTH)水平较治疗前显著降低,血钙、钙磷乘积水平较治疗前显著升高(P<0.05)。治疗后1个月,2组血钙较治疗前显著升高(P<0.05);治疗后12个月观察组iPTH水平显著低于对照组,而血钙、钙磷乘积水平显著高于对照组(P<0.05)。治疗后1、12个月2组血清铁蛋白和白蛋白水平显著升高,治疗后6个月达最高值(P<0.05);2组治疗后1、12个月C反应蛋白(CRP)水平有所下降,治疗后6个月CRP明显下降(P<0.05)。治疗后12个月观察组血清铁蛋白和白蛋白显著高于对照组(P<0.05)。治疗后6、12个月2组血红蛋白明显升高,且观察组显著高于对照组(P<0.05)。2组治疗后6、12个月EPO用量明显降低,且观察组显著低于对照组(P<0.05)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论 骨化三醇冲击治疗联合甲状旁腺全切术可改善肾衰竭继发性甲状旁腺功能亢进患者钙磷代谢和营养状态,减少EPO用量,对治疗安全性无明显影响。

Objective To explore the effect of calcitriol shock therapy combined with total parathyroidectomy(tPTx)on efficacy and calcium(Ca)and phosphorus(P)metabolism in renal failure patients with secondary hyperparathyroidism,and to observe the safety of drug therapy.Methods Between January 2020 and September 2022,90 renal failure patients with secondary hyperparathyroidism were selected and randomly divided into two groups:the control group(n=45)and the observation group(n=45)according to random number table method.The control group was treated with tPTx,and the observation group was supplemented with calcitriol shock therapy on the basis of the control group.The total effective rate,preoperative and postoperative Ca and P metabolism,inflammatory indicators and nutrition status indicators,hemoglobin,erythropoietin(EPO)dosage,and safety were compared between the two groups.Results The total effective rate of the observation group was significantly higher than that of the control group after treatment(93.33%vs.77.78%,P<0.05).At 6 and 12 months after treatment,serum intact parathyroid hormone(iPTH)levels were significantly lower,and serum Ca and Ca×P levels were significantly higher in both groups compared with those before treatment(P<0.05),At 1 month after treatment,the blood Ca levels in both groups significantly increased compared with those before treatment(P<0.05).At 12 months after treatment,the iPTH level in the observation group was significantly lower than that in the control group,while the levels of blood Ca and Ca×P were significantly higher than those in the control group(P<0.05).Serum ferritin(SF)and albumin(ALB)levels increased significantly in both groups at 1 and 12 months after treatment,and reached the highest value at 6 months after treatment(P<0.05).C reactive protein(CRP)decreased in both groups at 1 and 12 months after treatment,with a significant decrease at 6 months after treatment(P<0.05).SF and ALB were significantly higher in the observation group than in the control group(P<0.05).Hemoglobin increased significantly in both groups at 6 and 12 months after treatment,which was significantly higher in the observation group than in the control group(P<0.05).The dosage of EPO began to decrease in both groups at 6 and 12 months after treatment,which was significantly lower in the observation group than in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Calcitriol shock therapy combined with tPTx can improve the Ca and P metabolism and nutritional status of renal failure patients with secondary hyperparathyroidism,and decrease EPO dosage,without any significant impact on the safety of drug therapy.