张群芳盐酸西那卡塞对透析患者继发性甲状旁腺功能亢进的疗效观察.docVIP

盐酸西那卡塞对透析患者继发性甲状旁腺功能亢进的疗效观察 张群芳 上海大学 [摘要] 目的：观察西那卡塞对透析患者继发性甲状旁腺功能亢进(SHPT)的治疗作用。方法： 75例透析SHPT患者随机分为3组：VitD组（n＝25，罗盖全口服治疗4周），西那卡塞组（n＝25，西那卡塞口服治疗4周），联合治疗组（n＝25，罗盖全＋西那卡塞口服治疗4周）。比较治疗前后患者血钙、磷、PTH、钙磷乘积的变化。结果：①VitD组血PTH在治疗4周后较治疗前明显下降，但血钙、磷、钙磷乘积较前明显上升（随访过程中5例患者血钙＞2.8mmol/l退出）（P＜0.05）；西那卡塞组在治疗4周后血PTH、钙、磷、钙磷乘积较治疗前明显下降（随访过程中3例患者血钙＜1.9mmol/l退出）（P＜0.05）；联合治疗组在治疗4周后血PTH、钙、磷、钙磷乘积较治疗前明显下降，但下降均在可控范围内（P＜0.05）。②治疗4周后，联合治疗组患者血PTH下降的水平比另两组更加明显（P＜0.05）。结论：西那卡塞可有效治疗透析患者的SHPT，与活性维生素D制剂联合应用效果更为显著，且因其具有降低血钙的作用，尤其适用于伴有高钙血症者。 [关键词] 盐酸西那卡塞、透析、SHPT Observation of the Effect of Cinacalcet on Secondary HyperParaThyroidism in Dialysis Patients [Abstract] Objective To observe the therapeutic effect of Cinacalcet on secondary hyperparathyroidism (SHPT) in dialysis patients.? Methods 75cases of dialysis SHPT patients were randomly divided into 3 groups： VitD group（n＝25，Given Calcitriol oral treatment 4weeks），Cinacalcet group（n＝25，Given Cinacalcet oral treatment 4weeks），combined treatment?group（n＝25，Given Calcitriol and Cinacalcet oral treatment 4weeks）.Results VitD group:PTH was significantly lower than before treatment,but Serum calcium、phosphate、calcium-phosphorus product were significantly higher than before treatment（P＜0.05）. Cinacalcet group:. PTH and Serum calcium、phosphate、calcium-phosphorus product were significantly lower than before treatment（P＜0.05）. combined treatment?group:. PTH and Serum calcium、phosphate、calcium-phosphorus product were significantly lower than before treatment（P＜0.05）.And in combined treatment?group,the level of PTH was more pronounced than the other two groups（P＜0.05）.Conclusions Cinacalcet can be effective in the treatment of dialysis patients with SHPT, and active vitamin D preparation combined application effect is more significant and because of its lower blood calcium, Cinacalcet is especially suitable for the hypercalcaemia patients . [Key words] Cinacalcet、Dialysis、SHPT 近二十余年来，终末期肾病（end-stage renal disease，ESRD）的发病率和患病率在不断升高，美国肾脏数据登记系统（United States Renal