骨化三醇冲击治疗老年血液透析患者重度 甲状旁腺功能亢进的疗效对比.docVIP

精品论文 参考文献 骨化三醇冲击治疗老年血液透析患者重度 甲状旁腺功能亢进的疗效对比 申 伟 林敏娃 肖观清 孔耀中 佛山市第一人民医院肾内科 佛山 528000 【摘要】 目的 对比血液透析合并重度继发性甲状旁腺功能亢进症患者中青年人和老年人对骨化三醇的反应差异。方法 选择维持性血液透析患者中iPTH 水平均大于1000pg/ml的重度甲状旁腺功能亢进病人。根据年龄分为两组，A 组为18-65 岁，B 组为ge;65 岁。使用中剂量骨化三醇进行冲击治疗，2ug/次，每周3 次。疗程12 周，比较治疗前及治疗后的iPTH 及钙磷水平的变化。结果 共有符合条件患者54 例，A 组38 例，平均年龄为47.42plusmn;11.99 岁；B 组16 例，平均年 龄为75.50plusmn;6.38 岁。治疗前两组iPTH 水平无明显差异（(1569.50plusmn;460.11)pg/mlVS(1762.81plusmn;542.41)pg/ml，P=0.187）。治疗12 周后A 组和B组的iPTH 水平分别 降至(872.90plusmn;538.23)pg/ml和(724.61plusmn;575.87)pg/ml，对比无统计学差异（P=0.369）；但B组降幅明显大于A 组（(1038.21plusmn;717.37)pg/mlVS(696.60plusmn;459.36)pg/ml， P=0.041）。结论 在使用同等剂量骨化三醇进行冲击治疗时，老年患者iPTH 降低速度较年轻人显著加快。因此在使用骨化醇对老年患者进行冲击治疗时，应注意 剂量不宜过大，且密切关注iPTH 变化，及时调整，避免iPTH 过低造成低动力骨病。 【关键词】老年；骨化三醇；血液透析；甲状旁腺功能亢进症 Effect of pulse oral calcitriol on treatment of serious secondary hyperparathyroidism in elderly hemodialysis patients SHEN Wei, LIN Min-wa, XIAO Guan-qing, KONG Yao-zhong. Department of Nephrology, The first peoplersquo;s hospital of Foshan, Foshan, 52800, China Corresponding author: SHEN Wei, Email: dearshenwei@163.com 【Abstract】 Objectives The present study is to investigate the effect of pulse oral calcitriol on intact parathyroid hormone concentrations (iPTH) in the treatment of serious secondary hyperparathyroidism in elderly hemodialysis patients. Methods Maintenance hemodialysis patients whose iPTH was more than 1000pg/ml and liver function was normal were enrolled. Patients were distributed into two groups according their age. Group A was 18-65 years, while group B was more than 65 years. Each group gave oral calcitriol 2ug three times weekly for 12 weeks. Calcium and phosphate concentration, and especially iPTH concentrations were detected and analyzed. Target iPTH was less than 300pg/ml, and iPTH change more than -25% is defined as effective, while more than -50% as excellent. Results Fifty four subjects meet the inclusion criteria. Mean age of 38 subjects of group A i