西那卡塞治疗腹膜透析患者继发性甲状旁腺功能亢进的疗效
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摘要
目的观察西那卡塞治疗腹膜透析(腹透)患者继发性甲状旁腺功能亢进(SHPT)的临床疗效。方法 15例腹透患者SHPT采用西那卡塞25 mg治疗,每天1次。比较治疗前及治疗12周全段甲状旁腺激素(iPTH)、钙、磷、镁等指标的变化。结果治疗12周后,血清iPTH下降≥25%者11例。与治疗前相比,治疗12周后,血清iPTH降低[(619.51±288.88)%vs.(1074.91±434.58)%](P<0.01),钙升高[(2.57±0.26) mmol/L vs.(2.43±0.22) mmol/L](P<0.05),磷、钙磷乘积和镁水平差异无统计学意义(P>0.05)。治疗期间,1例患者出现恶心、呕吐等胃肠道不适,1例患者出现腹痛,1例患者治疗前存在睡眠欠佳、皮肤瘙痒、不宁腿综合征,均于相应处理后好转。结论西那卡塞治疗腹透患者SHPT可有效降低血清iPTH水平,不良反应少。
Objective To observe the clinical efficacy of cinacalcet in the treatment of secondary hyperparathyroidism in the patients undergoing peritoneal dialysis.Methods Fifteen peritoneal dialysis patients with secondary hyperparathyroidism were treated with cinacalcet 25 mg once a day for 12 weeks.Serum levels of intact parathyroid hormone(iPTH),calcium,phosphorus and magnesium were detected before and 12 weeks after treatment.Results Eleven patients with a decrease of iPTH more than 25% were found on the 12~(nd) week after treatment.Compared to before,serum level of iPTH was lower [(619.51±288.88)% vs.(1074.91±434.58)%] and calcium was higher [(2.57±0.26) mmol/L vs.(2.43±0.22) mmol/L] on the 12~(nd) week after treatment(P<0.01 or P<0.05),while the changes of phosphorus,calcium-phosphorus product and magnesium were not significant(P>0.05).During treatment,the adverse responses included nausea and vomiting in 1 case,abdominal pain in 1 case,poor sleep,itch of skin and restless leg syndrome in 1 case,which were improved after corresponding treatment.Conclusion The treatment with cinacalcet may effectively decrease serum level of iPTH with less adverse responses in peritoneal dialysis patients with secondary hyperparathyroidism.
Objective To observe the clinical efficacy of cinacalcet in the treatment of secondary hyperparathyroidism in the patients undergoing peritoneal dialysis.Methods Fifteen peritoneal dialysis patients with secondary hyperparathyroidism were treated with cinacalcet 25 mg once a day for 12 weeks.Serum levels of intact parathyroid hormone(iPTH),calcium,phosphorus and magnesium were detected before and 12 weeks after treatment.Results Eleven patients with a decrease of iPTH more than 25% were found on the 12~(nd) week after treatment.Compared to before,serum level of iPTH was lower [(619.51±288.88)% vs.(1074.91±434.58)%] and calcium was higher [(2.57±0.26) mmol/L vs.(2.43±0.22) mmol/L] on the 12~(nd) week after treatment(P<0.01 or P<0.05),while the changes of phosphorus,calcium-phosphorus product and magnesium were not significant(P>0.05).During treatment,the adverse responses included nausea and vomiting in 1 case,abdominal pain in 1 case,poor sleep,itch of skin and restless leg syndrome in 1 case,which were improved after corresponding treatment.Conclusion The treatment with cinacalcet may effectively decrease serum level of iPTH with less adverse responses in peritoneal dialysis patients with secondary hyperparathyroidism.
引文
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[8] 缪立英,金丽娜,沈建琴,等.西那卡塞对维持性血液透析继发甲状旁腺功能亢进患者血清FGF-23的影响[J].江苏医药,2016,42(13):1447-1449.
[9] Hu P,Xuan Q,Hu B,et al.Fibroblast growth factor-23 helps explain the biphasic cardiovascular effects of vitamin D in chronic kidney disease[J].Int J Biol Sci,2012,8(5):663-671.
[10] 刘颖.西那卡塞联合帕立骨化醇治疗血液透析患者继发性甲状旁腺功能亢进的疗效与安全性[J].实用药物与临床,2017,20(6):689-692.
[11] 刘玉梅.西那卡塞联合帕立骨化醇对血液透析继发性甲状旁腺功能亢进的疗效分析[J].现代实用医学,2017,29(7):891-892.
[12] 罗贞,史添立,周君,等.西那卡塞联合小剂量骨化三醇治疗透析患者继发性甲状旁腺功能亢进的疗效观察[J].临床肾脏病杂志,2017,17(7):431-434.
[2] Mizobuchi M,Ogata H,Koiwa F.Secondary hyperparathyroidism:pathogenesis and latest treatment[J].Ther Apher Dial,2018,4(5):1744-1746.
[3] 汪永辉,汪贤聪,林玲.难治性继发性甲状旁腺功能亢进的治疗进展[J].临床肾脏病杂志,2015,15(2):125-127.
[4] 赖贻旺.甲状旁腺切除术联合西那卡塞治疗继发性甲状旁腺功能亢进疗效分析[J].临床军医杂志,2018,46(12):1486-1487.
[5] Souqiyyeh MZ,Shaheen FA.Survey of attitudes of physicians toward the current evaluation and treatment of chronic kidney disease-mineral and bone disorder (CKD -MBD) [J].Saudi J Kidney Dis Transpl,2010,21(1):93-101.
[6] 张新,周焕,王晓慧,等.西那卡塞治疗血液透析患者继发性甲状旁腺功能亢进的临床观察[J].临床肾脏病杂志,2018,18(3):156-159.
[7] Block GA,Bushinsky DA,Cheng S,et al.Effect of etelcalcetide vs cinacalcet on serum parathyroid hormone in patients receiving hemodialysis with secondary hyperparathyroidism:a randomized clinical trial[J].JAMA,2017,317(2):156-164.
[8] 缪立英,金丽娜,沈建琴,等.西那卡塞对维持性血液透析继发甲状旁腺功能亢进患者血清FGF-23的影响[J].江苏医药,2016,42(13):1447-1449.
[9] Hu P,Xuan Q,Hu B,et al.Fibroblast growth factor-23 helps explain the biphasic cardiovascular effects of vitamin D in chronic kidney disease[J].Int J Biol Sci,2012,8(5):663-671.
[10] 刘颖.西那卡塞联合帕立骨化醇治疗血液透析患者继发性甲状旁腺功能亢进的疗效与安全性[J].实用药物与临床,2017,20(6):689-692.
[11] 刘玉梅.西那卡塞联合帕立骨化醇对血液透析继发性甲状旁腺功能亢进的疗效分析[J].现代实用医学,2017,29(7):891-892.
[12] 罗贞,史添立,周君,等.西那卡塞联合小剂量骨化三醇治疗透析患者继发性甲状旁腺功能亢进的疗效观察[J].临床肾脏病杂志,2017,17(7):431-434.