發(fā)布時(shí)間：2018-07-16 08:15

【摘要】：目的探討骨化三醇注射液和口服制劑沖擊治療維持性血液透析(MHD)患者繼發(fā)甲狀旁腺功能亢進(jìn)(SHPT)的療效及安全性。方法收集安徽醫(yī)科大學(xué)第二附屬醫(yī)院MHD并SHPT且不伴有高血鈣、高血磷的患者40例,隨機(jī)分為骨化三醇靜脈治療組(A組)和口服沖擊組(B組),療程12周。分別于治療前、治療后4、8和12周測(cè)定兩組血清全段甲狀旁腺激素(i PTH)、堿性磷酸酶(AKP)、鈣、磷水平,觀察癥狀改善及不良反應(yīng)。結(jié)果 (1)與治療前相比,治療4周后,兩組i PTH水平均明顯降低(P0.05);兩組在治療后AKP均有下降趨勢(shì),12周后,均出現(xiàn)明顯下降(P0.05)。(2)與B組比較,治療第8周,A組i PTH水平降低更為顯著,并在后續(xù)的治療中維持低于B組水平,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)血鈣變化:兩組在治療后均有血鈣升高趨勢(shì),B組血鈣改變明顯,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(4)血磷水平治療前后兩組差異均無統(tǒng)計(jì)學(xué)意義。(5)兩組臨床癥狀如骨痛、不寧腿、皮膚瘙癢和貧血等均有不同程度改善,其中A組瘙癢改善顯著(P0.05)。結(jié)論骨化三醇口服和靜脈沖擊治療均能有效降低MHD并SHPT患者的PTH和AKP,改善骨痛及瘙癢等癥狀。高鈣血癥是其主要的副作用。與口服沖擊治療比較,靜脈注射骨化三醇療效更為迅速及顯著,較少引起高鈣血癥,MHD患者使用安全方便,透析結(jié)束時(shí)給藥依從性較好。
[Abstract]:Objective to investigate the efficacy and safety of ossifying triol injection and oral preparation in the treatment of secondary hyperparathyroidism (SHPT) in patients with maintenance hemodialysis (MHD). Methods Forty patients with MHD and SHPT without hypercalcemia and high blood phosphorus were randomly divided into two groups: group A (group A) and group B (oral shock group). The course of treatment was 12 weeks. The serum levels of total parathyroid hormone (I PTH), alkaline phosphatase (AKP), calcium and phosphorus were measured before treatment, 4 weeks and 12 weeks after treatment, respectively. Results (1) after 4 weeks of treatment, the level of I). (in both groups was significantly lower than that before treatment (P0.05), and there was a tendency to decrease in both groups after 12 weeks of treatment (P0.05), which was significantly lower than that in group B (P0.05). At the 8th week of treatment, the level of I PTH in group A was significantly lower than that in group B, which was significantly lower than that in group B (P0.05). (3). The difference was statistically significant (P0.05). (4). (5) the clinical symptoms such as bone pain, restless legs, pruritus and anemia were improved in two groups, especially in group A (P0.05). Conclusion both oral and intravenous pulse therapy can effectively reduce PTH and AKP in patients with MHD and SHPT, and improve the symptoms of bone pain and pruritus. Hypercalcemia is its main side effect. Compared with oral shock therapy, intravenous injection of ossification triol was more rapid and significant, less caused hypercalcemia and MHD patients safe and convenient, and the drug compliance at the end of dialysis was better.
【作者單位】： 安徽醫(yī)科大學(xué)第二附屬醫(yī)院腎內(nèi)科;安徽省婦幼保健院腎內(nèi)科;
【基金】：安徽醫(yī)科大學(xué)2015年度校臨床科學(xué)研究項(xiàng)目(No:2015xkj110) 安徽省公益性研究聯(lián)動(dòng)項(xiàng)目(No:1604f0804021)
【分類號(hào)】：R459.5;R582.1

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