目的 探讨阿法骨化醇联合复方α酮酸片治疗肾性继发性甲状旁腺功能亢进症的临床研究。方法 选择2019年7月—2021年12月在宣城市中心医院治疗的90例患者，随机分对照组（45例）和治疗组（45例）。对照组患者随餐口服复方α酮酸片，6片/次，3次/d。治疗组在对照组的基础上口服阿法骨化醇软胶囊，0.5 μg/次，1次/d。两组治疗5周。观察两组患者临床疗效，比较治疗前后两组患者症状改善时间，血钙和血磷水平，甲状腺激素游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）和促甲状腺素（TSH）水平，血清因子甲状旁腺激素（PTH）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）和C反应蛋白（CRP）水平，及不良反应情况。结果 治疗后，治疗组临床有效率为97.78%，明显高于对照组的80.00%（P<0.05）。治疗后，治疗组骨骼疼痛、四肢肌力减弱、皮肤瘙痒等症状改善时间均早于对照组（P<0.05）。治疗后，两组血钙明显升高，而血磷、钙磷乘积指标明显降低（P<0.05）；且治疗组的血钙指标高于对照组，血磷、钙磷乘积指标均明显低于对照组（P<0.05）。治疗后，两组FT3、FT4水平明显降低，而TSH水平明显升高（P<0.05），且治疗组甲状腺激素水平明显好于对照组（P<0.05）。治疗后，两组患者血清因子IL-6、PTH、TNF-α、CRP水平明显下降（P<0.05），且治疗组明显低于对照组（P<0.05）。治疗期间，治疗组不良反应率（6.67%）明显低于对照组15.56%（P<0.05）。结论 阿法骨化醇软胶囊联合复方α酮酸片治疗肾性继发性甲状旁腺功能亢进症效果确切，能有效改善临床症状，可调节肾功能，纠正患者甲状旁腺激素，安全有效。

Objective To study the clinical effect of alfacalcidol combined with Compound α-Ketoacid Tablets in treatment of renal secondary hyperparathyroidism. Methods Patients (90 cases) with renal secondary hyperparathyroidism in Xuancheng City Central Hospital from July 2019 to December 2021 were randomly divided into control (45 cases) and treatment (45 cases) group. Patients in the control group were po administered with Compound α-Ketoacid Tablets, 6 tablets/time, three times daily. Patients in the treatment group were po administered with Alfacalcidol soft Capsules on the basis of the control group, 0.5 μg/time, once daily. Patients in two groups were treated for 5 weeks. After treatment, the clinical evaluation was evaluated, the improvement time of symptoms, the levels of blood calcium, blood phosphorus and calcium phosphorus product, FT3, FT4 and TSH, the levels of IL-6, PTH, TNF-α and CRP, and the adverse reactions in two groups before and after treatment were compared. Results The effective rate of the treatment group was 97.78%, which was higher than that of the control group (80.03%, P<0.05). After treatment, the improvement time of bone pain, weakening of muscle strength of extremities and skin pruritus in the treatment group was earlier than that in the control group (P < 0.05). After treatment, blood calcium was significantly increased, while blood phosphorus and calcium-phosphorus product were significantly decreased in two groups (P < 0.05), and these indexes in the treatment group were significantly better than those in the control group (P < 0.05). After treatment, the levels of FT3 and FT4 in two groups were significantly decreased, while the level of TSH were significantly increased (P < 0.05), and the level of thyroid hormone in the treatment group was significantly better than that in the control group (P < 0.05). After treatment, the levels of serum factors IL-6, PTH, TNF-α and CRP in two groups were significantly decreased, and which in the treatment group were significantly lower than those in the control group (P < 0.05). During the treatment, the adverse reaction rate in the treatment group (6.67%) was significantly lower than that in the control group (15.56%) (P < 0.05). Conclusion Alfacalcidol combined with Compound α-Ketoacid Tablets are effective in the treatment of clinical symptoms, can regulate renal function and correct parathyroid hormone, which is safe and effective.

R976

慢病防治联合基金立项项目（MBLHJJ202008）