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[摘要]
目的 研究西那卡塞联合骨化三醇治疗尿毒症血液透析继发性甲状旁腺功能亢进患者的临床疗效。方法 选择2016年1月-2018年12月新疆喀什地区第一人民医院的96例尿毒症血液透析继发性甲状旁腺功能亢进患者作为研究对象。采用抽签法将患者随机分为对照组和观察组,每组各48例。对照组口服骨化三醇胶丸,初始给药剂量为0.25 μg/d,3次/周,每15天调整1次给药剂量,最高剂量为0.5 μg/d。观察组在对照组治疗的基础上整片吞服盐酸西那卡塞片,初始给药剂量为25 mg/d,每15天调整1次给药剂量,最高剂量为75 mg/d。两组均持续治疗3个月。观察两组患者的临床疗效,比较两组治疗前后的相关血清学指标和甲状旁腺体积。结果 治疗后,观察组的有效率为93.75%,明显高于对照组的77.08%,两组比较差异具有统计学意义(P<0.05)。治疗后,两组的血钙水平和钙磷乘积明显升高,血磷、血清全段甲状旁腺激素(iPTH)水平明显降低,观察组的血清成纤维细胞生长因子23(FGF23)和骨特异性碱性磷酸酶(BSAP)水平明显降低(P<0.05),且观察组的血清指标水平明显优于对照组(P<0.05)。两组治疗后的甲状旁腺体积均明显降低(P<0.05),观察组明显更低(P<0.05)。结论 西那卡塞联合骨化三醇可以有效缓解患者的钙磷代谢异常情况,明显降低血清BSAP和FGF23水平,且不会使不良反应增加。
[Key word]
[Abstract]
Objective To study the clinical efficacy of cinacalcet combined with calcitriol in treatment of secondary hyperparathyroidism in uremia hemodialysis patients. Methods A total of 96 patients with secondary hyperparathyroidism in uremia hemodialysis in First People's Hospital of Kashgar from January 2016 to December 2018 were selected as study subjects. The patients were randomly divided into control group and observation group by lottery, with 48 patients in each group. Patients in the control group were po administered with Calcitriol Soft Capsules, the initial dose was 0.25 μg/d, three times weekly, and the dose was adjusted once every 15 days. The maximum dose was 0.5 μg/d. Patients in the observation group were po administered with Cinacalcet Hydrochloride Tablets on the basis of the control group, the initial dose was 25 mg/d, and the dose was adjusted once every 15 days, with the highest dose being 75 mg/d. Both groups were treated continuously for 3 months. After treatment, the clinical efficacy in two groups was observed, and the relevant serological indexes and parathyroid volume before and after treatment were compared between two groups. Results After treatment, the effective rate of the observation group was 93.75%, which was significantly higher than 77.08% of the control group, and the difference between two groups was statistically significant (P<0.05). After treatment, serum calcium and calcium phosphorus product were significantly increased, but the levels of serum phosphorus and serum iPTH were significantly decreased, and serum FGF23 and BSAP levels of the observation group were significantly decreased (P<0.05). And serum index levels of the observation group were significantly better than those of the control group (P<0.05). After treatment, the volume of parathyroid glands in two groups was significantly reduced (P<0.05), while that in the observation group was significantly lower (P<0.05). Conclusion The combination of cinacalcet and calcitriol can effectively alleviate the abnormal calcium and phosphorus metabolism in patients, significantly reduce the serum BSAP and FGF23 levels, and will not increase the adverse reactions.
[中图分类号]
R977
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