鹿冬梅,杨沿浪,王金宝,童昌军,高潮清,周健美
LU Dongmei,YANG Yanlang,WANG Jinbao,TONG Changjun,GAO Chaoqing,ZHOU Jianmei

• 1:皖南医学院弋矶山医院血液净化中心

摘要(Abstract)：

目的:探讨西那卡塞联合骨化三醇对不同基线全段甲状旁腺素(iPTH)水平患者维持性血液透析(MHD)尿毒症继发性甲状旁腺功能亢进(SHPT)患者矿物质及骨代谢的影响。方法:92例MHD伴SHPT患者均分为观察组与对照组,观察组与对照组再根据血清iPTH水平分为300～500、501～1 000及>1 000 ng/L组;对照组给予常规骨化三醇治疗,观察组在对照组基础上联用西那卡塞治疗;比较各组患者治疗前及治疗4、12、24周时血清钙、血清磷及iPTH水平,比较治疗前及治疗12周时各组患者碱性磷酸酶(ALP)、骨保护素(OPG)、β-胶原蛋白(β-CTX)水平,比较治疗前及治疗24周时各组患者骨密度(BMD)水平。结果:各组患者治疗前的上述指标比较,差异无统计学意义(P>0.05),治疗4、12、24周时,2组患者血清钙及BMD比较差异无统计学意义(P>0.05),观察组的血清磷、iPTH、血清ALP、OPG及β-CTX显著低于对照组,且随基线iPTH值的降低变化越显著(P<0.05)。结论:西那卡塞联合骨化三醇可改善MHD伴SHPT患者的矿物质代谢及骨代谢紊乱,但短期内对BMD的影响较小。
Objective: To investigate the effect of cinacalcet combined with calcitriol on the mineral and bone metabolism of secondary hyperparathyroidism(SHPT) in patients with maintenance hemodialysis(MHD).Methods:92 cases of MHD patients with SHPT were randomly divided into observation group and control group and both of them were further divided into 300～500,501～1 000 and >1 000 ng/L according to the serum iPTH level.The control group received calcitriol pulse therapy,the observation group received cinacalcet therapy on the basis of the control group.The serum calcium,phosphorus,intact parathyroid hormone(iPTH),alkaline phosphatase(ALP),osteoprotegerin(OPG),and β-collagen(β-CTX) were detected before and after treatment,and the bone mineral density(BMD) levels.Results:There were no statistically significant differenceswith all indicators of each group compared before treatment(P>0.05).There were no significant differences in BMD and serum calcium between the two groups at 4,12,and 24 weeks after treatment(P>0.05),but the serum levels of phosphorus,iPTH,ALP,OPG and β-CTX in the observation group were significantly lower than those in the control group(P<0.05),and there was the more obvious improvement with the lower baseline iPTH value(P<0.05).The compliance rate of iPTH was the highest in the baseline iPTH<500 ng/L patients,but there was no significant difference between the observation group and the control group(P>0.05).Conclusion:Cinacalcet combined with calcitriol can improve the mineral and bone meta-bolism disorders of MHD patients with SHPT,but it has little effect on BMD in the short term.

关键词(KeyWords)： 甲状旁腺功能亢进,继发性;血液透析;西那卡塞;骨化三醇;矿物质;骨代谢
hyperparathyroidism,secondary;hemodialysis;cinacalcet;calcitriol;minerals;bone metabolism

Abstract:

Keywords:

基金项目(Foundation): 安徽省卫生计生委科研计划项目(2016QK071)

作者(Author): 鹿冬梅,杨沿浪,王金宝,童昌军,高潮清,周健美
LU Dongmei,YANG Yanlang,WANG Jinbao,TONG Changjun,GAO Chaoqing,ZHOU Jianmei

DOI: 10.19367/j.cnki.1000-2707.2019.08.020

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