活性维生素D治疗继发性甲状旁腺功能亢进对红细胞免疫功能和SIL2R影响.docVIP

活性维生素D治疗继发性甲状旁腺功能亢进对红细胞免疫功能和SIL2R影响 　　[摘要] 目的:研究活性维生素D治疗尿毒症合并继发性甲状旁腺功能亢进(SHPT)对红细胞免疫功能和可溶性白细胞介素-2受体(SIL-2)的影响。方法:选择健康体检者35人为正常对照组,尿毒症维持性血液透析合并SHPT患者34例为患者组,患者组在血液透析等其他综合治疗的基础上,应用活性维生素D(罗盖全)冲击治疗SHPT。血清全段甲状旁腺激素(iPTH)≥300而1 000 pg?ml-1者应用罗盖全4 μg,夜间睡前口服;当血清iPTH降至150~300 pg?ml-1后罗盖全减量50%,并根据iPTH水平调整剂量,维持iPTH 150~300 pg?ml-1,疗程20周,治疗前、后检测血清Ca2+、P3+、白蛋白、碱性磷酸酶、红细胞、血红蛋白、白细胞、肌酐、尿素氮、红细胞膜C3b受体花环率(RCR)、SIL-2R。结果:患者组RCR和SIL-2R较正常对照组均明显降低(P0.01)。罗盖全冲击治疗尿毒症合并SHPT,随着PTH的下降,患者组RCR和SIL-2R均较治疗前明显升高,与治疗前相比差异显著(P0.05或P0.01)。结论:活性维生素D冲击治疗尿毒症合并SHPT,能有效降低iPTH水平,患者的红细胞免疫功能和T淋巴细胞活化功能均明显改善。? 　　[关键词] 活性维生素D; 继发性甲状旁腺功能亢进; 红细胞免疫功能; 血清可溶性白细胞介素2受体? 　　[中图分类号] R582.1 [文献标识码] A [文章编号] 1671-7562(2010)04-0358-03? 　　doi:10.3969/j.issn.1671-7562.2010.04.011?? 　　 　　Effects of active vitamin D treatment of secondary hyperparathyroidism on? 　　 immune function of RBC and SIL-2R?? 　　XIA Chun?ying, YAO Li?qun, SHAO Wei?bin, CHEN Xue?ying, LIU Xiao?xian 　　(Department of Nephrology, the Affiliated People?s Hospital of Jiangsu University, Zhenjiang 212002, China)?? 　　 　　[Abstract] Objective: To study the effects of active vitamin D treatment of uremia combined with secondary hyperparathyroidism (SHPT) on immune function of red blood cell and soluble interleukin-2 receptor (SIL-2). Methods: Control group were 35 healthy people, the patient group were 34 cases of hemodialysis patients with SHPT. Patients with serum (parathyroid hormone) iPTH≥300 and 500 pg?ml-1 used rocaltrol 1 μg, biw; patients with serum iPTH 500-1 000 pg?ml-1 used rocaltrol 2 μg, biw; patients with serum iPTH above 1 000pg?ml-1 used rocaltrol 4 μg, biw. When the serum iPTH reduced to 150-300 pg?ml-1, rocaltrol reduced 50%, and adjust the dose according to iPTH levels, maintain iPTH 150-300 pg?ml-1, observed for 20 weeks. The serum Ca2+, P3+, ALB, AKP, RBC, Hb, WBC, SCr, BUN, RCR, SIL-2R before and after treatment were delected. Results: The RCR and SIL-2R level of patient group were significantly lower than normal control group (P0.01