西那卡塞联合骨化三醇冲击治疗血液透析患者重度继发性甲状旁腺功能亢进疗效及安全性
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摘要
目的探讨盐酸西那卡塞联合骨化三醇冲击治疗对维持性血液透析并发重度继发性甲状旁腺功能亢进患者的疗效及安全性。方法选取自2016年10月至2017年10月收治的7例维持性血液透析并发重度继发性甲状旁腺功能亢进患者为研究对象。给予患者口服盐酸西那卡塞联合骨化三醇冲击治疗,根据治疗后血清全段甲状旁腺激素、血钙情况调整骨化三醇剂量或加用钙剂,治疗8周。分别于治疗前及治疗后2、4、8周测定患者血清全段甲状旁腺激素、血钙、血磷水平,并记录患者临床症状缓解程度及不良反应发生情况。结果治疗后2、4、8周,患者全段甲状旁腺激素、血钙、血磷均较治疗前明显降低,差异均有统计学意义(P <0. 05)。治疗后,患者皮肤瘙痒、肌肉酸痛、全身乏力等症状均明显好转。治疗过程中,出现低钙血症1例,加用钙剂后缓解。结论盐酸西那卡塞联合骨化三醇冲击治疗对维持性血液透析并发重度继发性甲状旁腺功能亢进患者的短期疗效明显,安全性较高,但长期疗效及能否推广应用还需进一步观察。
Objective To investigate the efficacy and safety of cinacalcet combined with calcitriol impact therapy on severe secondary hyperparathyroidism( SHPT) in patients with maintenance hemodialysis( MHD). Methods The patients were given oral administration of sinacase hydrochloride combined with shock therapy of calcitriol,and the dose of calcitriol or calcium was adjusted according to the serum level of parathyroid hormone and serum calcium after treatment for 8 weeks. Serum levels of parathyroid hormone,serum calcium and serum phosphorus were measured before and 2,4 and 8 weeks after treatment,respectively,and the clinical symptom relief degree and adverse reactions were recorded. Results Two,four and eight weeks after treatment,parathyroidhormone,serum calcium and serum phosphorus in the whole segment of the patients were significantly lower than before treatment( P < 0. 05). After treatment,the patients' skin itching,musclepain,fatigue and other symptoms were significantly improved. In the course of treatment,1 case of hypocalcemia occurred,which was relieved after adding calcium. Conclusion The short term effect of cinacalcet combined with calcitriol shock therapy for maintenance hemodialysis patients with severe SHPT is obvious,and it has high security,while the long-term effect and whether it can be popularized need further observation.
Objective To investigate the efficacy and safety of cinacalcet combined with calcitriol impact therapy on severe secondary hyperparathyroidism( SHPT) in patients with maintenance hemodialysis( MHD). Methods The patients were given oral administration of sinacase hydrochloride combined with shock therapy of calcitriol,and the dose of calcitriol or calcium was adjusted according to the serum level of parathyroid hormone and serum calcium after treatment for 8 weeks. Serum levels of parathyroid hormone,serum calcium and serum phosphorus were measured before and 2,4 and 8 weeks after treatment,respectively,and the clinical symptom relief degree and adverse reactions were recorded. Results Two,four and eight weeks after treatment,parathyroidhormone,serum calcium and serum phosphorus in the whole segment of the patients were significantly lower than before treatment( P < 0. 05). After treatment,the patients' skin itching,musclepain,fatigue and other symptoms were significantly improved. In the course of treatment,1 case of hypocalcemia occurred,which was relieved after adding calcium. Conclusion The short term effect of cinacalcet combined with calcitriol shock therapy for maintenance hemodialysis patients with severe SHPT is obvious,and it has high security,while the long-term effect and whether it can be popularized need further observation.
引文
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[3]王丽君.骨化三醇冲击治疗血透患者继发性甲状旁腺功能亢进的研究进展[J].中国处方药,2017,15(8):9-10.
[4]匡彬.西那卡塞联合骨化三醇对血透患者继发性甲状旁腺功能亢进的治疗效果研究[J].现代诊断与治疗,2016,27(10):1771-1773.
[5]茅宇烽,朱淳.慢性肾病钙磷代谢状况分析[J].创伤与急危重病医学,2018,6(5):267-269.
[6]王海燕,赵明辉,张宏,等.肾脏病临床概览[M].北京:北京大学医学出版社,2010:463-465.
[7]李铎,宋韩明,李文歌,等.难治性继发性甲状旁腺功能亢进的相关因素分析[J].肾脏病与透析肾移植杂志,2012,21(2):115-119.
[8]刁宗礼,郭维康,刘莎,等.继发性甲状旁腺功能亢进的药物治疗进展[J].中国全科医学,2015,18(26):3245-3247,3252.
[9]Verheyen N,Pilz S,Eller K,et al. Cinacalcet hydrochloride for the treatmentof hyperparathyroidism[J]. Expert Opin Pharmacother,2013,14(6):793-806.
[10]Tatsumi R,Komaba H,Kanai G,et al. Cinacalcet induces apoptosis in parathyroid cells in patients with secondary hyperparathyroidism:histological and cytological analyses[J]. Nephron Clin Pract,2013,124(3-4):224-231.
[11]操凤.低剂量西那卡塞治疗血透合并中重度继发性甲亢患者的疗效观察[J].江西医药,2017,52(10):1006-1008.
[2]石平,章亮,张玉新,等.低钙透析联合骨化三醇冲击治疗在维持性血液透析患者继发性甲旁亢中的应用[J].海南医学,2012,23(6):35-37.
[3]王丽君.骨化三醇冲击治疗血透患者继发性甲状旁腺功能亢进的研究进展[J].中国处方药,2017,15(8):9-10.
[4]匡彬.西那卡塞联合骨化三醇对血透患者继发性甲状旁腺功能亢进的治疗效果研究[J].现代诊断与治疗,2016,27(10):1771-1773.
[5]茅宇烽,朱淳.慢性肾病钙磷代谢状况分析[J].创伤与急危重病医学,2018,6(5):267-269.
[6]王海燕,赵明辉,张宏,等.肾脏病临床概览[M].北京:北京大学医学出版社,2010:463-465.
[7]李铎,宋韩明,李文歌,等.难治性继发性甲状旁腺功能亢进的相关因素分析[J].肾脏病与透析肾移植杂志,2012,21(2):115-119.
[8]刁宗礼,郭维康,刘莎,等.继发性甲状旁腺功能亢进的药物治疗进展[J].中国全科医学,2015,18(26):3245-3247,3252.
[9]Verheyen N,Pilz S,Eller K,et al. Cinacalcet hydrochloride for the treatmentof hyperparathyroidism[J]. Expert Opin Pharmacother,2013,14(6):793-806.
[10]Tatsumi R,Komaba H,Kanai G,et al. Cinacalcet induces apoptosis in parathyroid cells in patients with secondary hyperparathyroidism:histological and cytological analyses[J]. Nephron Clin Pract,2013,124(3-4):224-231.
[11]操凤.低剂量西那卡塞治疗血透合并中重度继发性甲亢患者的疗效观察[J].江西医药,2017,52(10):1006-1008.