摘要
目的探讨西那卡塞对血液透析继发性甲状旁腺功能亢进患者血钙(Ca)、血磷(P)、全段甲状旁腺素(iPTH)水平的影响,为进一步提升临床治疗效果提供参考和依据。方法选取南京市中心医院2016年1月至2021年6月收治的60例行血液透析治疗后继发性甲状旁腺功能亢进患者作为研究对象,依据随机数字表法分为对照组和观察组,每组患者均为30例。予以对照组患者磷结合剂、维生素D类似物等常规对症支持治疗,在对照组治疗基础上,予以观察组患者盐酸西那卡塞片治疗,两组患者治疗时间均为3个月。对两组患者治疗后的临床疗效,治疗前后尿素氮(BUN)、血肌酐(SCr)、尿素清除指数(KT/V)、血红蛋白(Hb)水平、甲状旁腺大小、Ca、P、钙磷乘积、iPTH水平,以及治疗期间不良反应发生情况进行对比分析。结果治疗后,观察组患者的总有效率为96.67%,显著高于对照组的73.33%;相较于治疗前,治疗后两组患者外周血Hb水平均显著升高,且观察组显著高于对照组;治疗后两组患者甲状旁腺长、宽、厚、体积均显著减小,且观察组显著小于对照组;治疗后两组患者Ca、P、钙磷乘积、iPTH水平均显著降低,且观察组显著低于对照组;治疗期间,观察组患者的不良反应总发生率为13.33%,显著低于对照组的40.00%(均P<0.05);两组患者治疗前后组间、组内BUN、SCr、KT/V水平比较,差异均无统计学意义(均P>0.05)。结论西那卡塞可有效缩小血液透析继发性甲状旁腺功能亢进患者的甲状旁腺体积,降低患者机体内甲状旁腺激素水平,调节患者的血Ca、P水平,疗效显著,且安全性良好。
Objective To investigate the effect of Cinacalcet on the levels of serum calcium(Ca),serum phosphorus(P)and intact parathyroid hormone(iPTH)in patients with hyperparathyroidism secondary to hemodialysis,providing reference and basis for further improving the clinical treatment effect.Methods A total of 60 patients with hyperparathyroidism secondary to hemodialysis who were admitted to Nanjing Central Hospital from January 2016 to June 2021 were selected as the research subjects,according to the random number table method,they were divided into control group and observation group,there were 30 patients in each group.The control group were given routine symptomatic and supportive treatment such as Phosphorus binders and Vitamin D analogs,on the basis of the control group,the patients in the observation group were treated with Cinacalcet hydrochloride tablets,the two groups of patients were treated for 3 months.The clinical efficacy after treatment,blood urea nitrogen(BUN),serum creatinine(SCr),urea clearance index(KT/V),hemoglobin(Hb)level,parathyroid gland size,Ca,P,calcium-phosphorus product,iPTH level before and after treatment,the incidence of adverse reactions during the treatment period were compared and analyzed between the two groups.Results After treatment,the total effective rate of patients in the observation group were 96.67%,which was significantly higher than 73.33%of the control group;compared with before treatment,after treatment the levels of peripheral blood Hb in the two groups significantly increased,and the observation group was significantly higher than the control group;after treatment the length,width,thickness and volume of parathyroid glands in the two groups significantly reduced,and the observation group was significantly smaller than the control group;after treatment the levels of Ca,P,calcium-phosphorus product and iPTH in the two groups significantly decreased,and the observation group was significantly lower than the control group;during treatment,the total incidence of adverse reactions in the observation group were 13.33%,which was significantly lower than 40.00%of the control group(all P<0.05);there was no significant difference in the levels of BUN,SCr and KT/V between the two groups before and after treatment(all P>0.05).Conclusion Cinacalcet can effectively reduce the volume of parathyroid glands in patients with hyperparathyroidism secondary to hemodialysis,reduce the level of parathyroid hormone,regulate the serum Ca and P levels of patients,with significant effect,and security is good.
作者
董海霞
朱燕
DONG Haixia;ZHU Yan(Department of Nephrology,Nanjing Central Hospital,Nanjing,Jiangsu 210018,China)
作者简介
董海霞,硕士研究生,副主任医师,研究方向:肾内科相关疾病的诊疗。
