摘要
目的：观察起始剂量0.06～0.08 μg/kg的帕立骨化醇治疗血液透析伴继发性甲状旁腺功能亢进患者12周的有效性和安全性. 方法：入选南京军区南京总医院肾脏科血液净化中心维持性血液透析＞3个月的患者11例（男性8例,女性3例）,全部全段甲状旁腺激素（iPTH）＞ 600 pg/ml,血钙≤2.60 mmol/l,钙磷乘积≤65mg2/dl2,帕立骨化醇起始剂量0.06～0.08 μg/kg,每4周复查iPTH,每2周复查钙、磷,治疗12周.根据iPTH下降幅度调整药物剂量,主要疗效指标为治疗12周iPTH较基线水平下降＞30％;次要疗效指标包括：治疗12周iPTH下降率,iPTH降至正常范围（150～300 pg/ml）的患者例数,药物剂量变化,血钙、血磷、钙磷乘积变化及不良事件发生. 结果：基线iPTH 1 087.0 pg/ml（802.9～1 413.0 pg/ml）,血钙2.30±0.19 mmol/L,血磷1.60±0.24 mmol/L.帕立骨化醇起始剂量6例为0.06 μg/kg,5例为0.08 μg/kg,第12周时帕立骨化醇平均用量为0.11μg/kg,有6例患者在第8周即调整达到治疗剂量.11例患者有8例iPTH下降＞30％,其中4例降至150～ 300 pg/ml,血钙平均升高8.6％,血磷平均升高21.2％,无明显不良反应发生. 结论：中等起始剂量的帕立骨化醇能有效降低iPTH水平,同时血钙、磷变化相对稳定.
Objective： To observe the efficacy and safety of paricalcitol in treatment of secondary hyperparathyroidism （SI-IPT） in maintenance hemodialysis （MHD） patients at a medium initial dose of 0. 06-0. 08 μg/kg. Methodology：Eleven MHD patients （8 males and 3 females） were enrolled to receive intravenous injection of paricalcitol thrice weekly for treatment of SHPT, with inclusion criteria as follows ： maintenance on HD 〉 3 months, serum intact parathyroid hormone （iPTH） ≥600 pg/ml, serum Ca （calcium） ≤2. 6 mmol/L, and Ca x phosphorus （P） ≤ 65 mg2/di2. During 12-weeks- follow-up, serum Ca and P were measured per 2 weeks and iPTH was measured per 4 weeks. Dose of paricalcitol was adjusted according to the measurements results. Results：The baseline levels of iPTH, Ca, and P were 1 087 （627~3 341） pg/ml, 2. 30±0. 19 mmol/L, and 1.60±0. 24 mmol/L, respectively. The initial dose was 0. 06 μg/kg in 6 patients and 0. 08 μg/kg in other 5 patients. The final average dose was 0. 11μg/kg at the end of follow-up, with 6 patients achieving dose adjustment reaching desired level within 8 weeks. One patient dropped out due to skin lesion. The proportion of patients with iPTH reduction by 〉30% and with iPTH reducing to 150-300 pg/ml was 73% and 36. 4%, respectively, with one patient experiencing hypercalciumemia. No other adverse events were observed. Conclusion： It seemed feasible to initiate paricaleit91 treatment at a medium dose in SHPT hemodilysis patients, with few effect on serum Ca and P levels.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
北大核心
2015年第1期1-5,共5页
Chinese Journal of Nephrology,Dialysis & Transplantation
基金
国家科技支撑课题(2013BAI09B04)
作者简介
[通信作者]龚德华（E-mail：gong_doctor@126．com）
[通信作者]刘志红（E—mail：liuzhihong@nju．edu．cn）
