骨化三醇静脉注射与口服冲击治疗继发性甲状旁腺功能亢进患者的临床疗效观察
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摘要
目的对比骨化三醇静脉注射与口服冲击治疗继发性甲状旁腺功能亢进患者临床疗效及安全性。方法选取本院2014年9月～2017年9月收治的104例继发性甲状旁腺功能亢进的维持性血液透析患者,按照随机数字表法分为观察组与对照组,每组各52例。对照组给予骨化三醇口服治疗,观察组给予骨化三醇静脉注射治疗,两组患者均治疗12周。分别于治疗前、治疗后4、8、12周测定两组患者血清全段甲状旁腺激素(iPTH)、碱性磷酸酶(AKP)、钙、磷水平,比较两组患者临床疗效及不良反应情况。结果治疗后,两组患者骨痛、贫血、瘙痒、不宁腿症状均有不同程度改善,但观察组骨痛、皮肤瘙痒症状较对照组改善更显著,差异有统计学意义(P<0.05);治疗后,观察组不同时间点血钙、血磷水平差异均无统计学意义(P>0.05),对照组不同时间点血钙、血磷水平差异均有统计学意义(P<0.05),且两组患者治疗4、8、12周血钙、血磷水平比较差异均无统计学意义(P>0.05);两组患者治疗4、8、12周AKP、iPTH水平比较差异均有统计学意义(P<0.05);观察组患者治疗后总有效率对照组比较,差异有统计学意义(P<0.05);观察组不良反应总发生率明显低于对照组,差异有统计学意义(P<0.05)。结论骨化三醇静脉注射治疗较口服冲击治疗临床疗效更显著,且能有效降低iPTH、AKP水平,维持钙磷平衡,无严重不良反应,安全有效,可在临床上推广使用。
Objective To investigate the clinical efficacy and safety of calcitriol intravenous injection and oral granules in the treatment of secondary hyperparathyroidism.Methods 104 patients with secondary hyperparathyroidism who underwent maintenance hemodialysis from September 2014 to September 2017 in our hospital were enrolled.According to random number table,the patients were divided into observation group and control group.The control group was given oral calcitriol treatment and the observation group was given intravenous calcitriol treatment.Both groups were treated for 12 weeks.The clinical data of two groups were retrospectively analyzed.Serum total parathyroid hormone(iPTH),alkaline phosphatase(AKP),serum creatinine Calcium level,phosphorus level were observed.The clinical effects of two groups were compared and analyzed to observe the improvement of their symptoms and adverse reactions.Results After treatment,the symptoms of bone pain,anemia,pruritus and restless legs in both groups were improved to some extent.The symptoms of pruritus in the observation group improved significantly(the difference was statistically significant(P<0.05).There was no significant difference in the improvement of other symptoms after treatment,with no significant difference(P>0.05).After treatment on the changes of serum calcium,the observation group at different time points no significant difference in serum calcium levels(P>0.05).The difference of blood calcium level in control group at different time points was obvious(P<0.05).There was no significant difference between the two groups in the difference of blood calcium levels at 4 weeks,8 weeks and 12 weeks(P>0.05).The observation group at different time points no significant difference in serum phosphorus levels(P>0.05).The control group had no significant difference in serum phosphorus levels at different time points(P>0.05).There was no significant difference in serum phosphorus levels between the two groups after 4,8 and 12 weeks of treatment(P>0.05).The AKP level of the observation group at different time points showed significant difference(P<0.05).The difference of AKP level in control group at different time points was significant(P<0.05).AKP levels in both groups after treatment for 4 weeks,8 weeks and 12 weeks were significantly different(P<0.05).The observation group at different time points iPTH levels were significantly different(P<0.05).The difference of iPTH level in control group at different time points was significant(P<0.05).There were significant differences in iPTH levels between the two groups after 4,8 and 12 weeks of treatment(P<0.05).The total effective rate of observation group was 50 cases(96.15%)after treatment,while the total effective rate of control group was 41 cases(78.85%)after treatment.The observation group's total effective rate was significantly higher than the control group(P<0.05).After treatment,the total incidence of adverse reactions in the observation group was 5.77%.The incidence of adverse reactions in the control group was 19.23%.The incidence of adverse reactions in the control group was significantly higher than that in the observation group(P<0.05).Conclusion For the treatment of secondary hyperparathyroidism,intravenous calcitriol injection compared with oral granules can effectively reduce the level of iPTH and AKP,maintain calcium and phosphorus balance and has no serious adverse reactions.
Objective To investigate the clinical efficacy and safety of calcitriol intravenous injection and oral granules in the treatment of secondary hyperparathyroidism.Methods 104 patients with secondary hyperparathyroidism who underwent maintenance hemodialysis from September 2014 to September 2017 in our hospital were enrolled.According to random number table,the patients were divided into observation group and control group.The control group was given oral calcitriol treatment and the observation group was given intravenous calcitriol treatment.Both groups were treated for 12 weeks.The clinical data of two groups were retrospectively analyzed.Serum total parathyroid hormone(iPTH),alkaline phosphatase(AKP),serum creatinine Calcium level,phosphorus level were observed.The clinical effects of two groups were compared and analyzed to observe the improvement of their symptoms and adverse reactions.Results After treatment,the symptoms of bone pain,anemia,pruritus and restless legs in both groups were improved to some extent.The symptoms of pruritus in the observation group improved significantly(the difference was statistically significant(P<0.05).There was no significant difference in the improvement of other symptoms after treatment,with no significant difference(P>0.05).After treatment on the changes of serum calcium,the observation group at different time points no significant difference in serum calcium levels(P>0.05).The difference of blood calcium level in control group at different time points was obvious(P<0.05).There was no significant difference between the two groups in the difference of blood calcium levels at 4 weeks,8 weeks and 12 weeks(P>0.05).The observation group at different time points no significant difference in serum phosphorus levels(P>0.05).The control group had no significant difference in serum phosphorus levels at different time points(P>0.05).There was no significant difference in serum phosphorus levels between the two groups after 4,8 and 12 weeks of treatment(P>0.05).The AKP level of the observation group at different time points showed significant difference(P<0.05).The difference of AKP level in control group at different time points was significant(P<0.05).AKP levels in both groups after treatment for 4 weeks,8 weeks and 12 weeks were significantly different(P<0.05).The observation group at different time points iPTH levels were significantly different(P<0.05).The difference of iPTH level in control group at different time points was significant(P<0.05).There were significant differences in iPTH levels between the two groups after 4,8 and 12 weeks of treatment(P<0.05).The total effective rate of observation group was 50 cases(96.15%)after treatment,while the total effective rate of control group was 41 cases(78.85%)after treatment.The observation group's total effective rate was significantly higher than the control group(P<0.05).After treatment,the total incidence of adverse reactions in the observation group was 5.77%.The incidence of adverse reactions in the control group was 19.23%.The incidence of adverse reactions in the control group was significantly higher than that in the observation group(P<0.05).Conclusion For the treatment of secondary hyperparathyroidism,intravenous calcitriol injection compared with oral granules can effectively reduce the level of iPTH and AKP,maintain calcium and phosphorus balance and has no serious adverse reactions.
引文
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[22]赵亚娟,黄兰,辛立升,等.骨化三醇冲击治疗对血液透析继发性甲状旁腺功能亢进症及FGF23的作用[J].河北医学,2016,22(11):1861-1863.
[23] Baón S,Rosillo M,Gómez A,et al.Effect of a monthly doseof calcidiol in improving vitamin D deficiency and secondary hy-perparathyroidism in HIV-infected patients[J].Endocrine,2015,49(2):528-537.
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[2]张伟耀,邓惠玲,吴又明,等.腹腔镜下甲状旁腺全切除、部分腺体移植术治疗肾性继发性甲状旁腺功能亢进症[J].实用医学杂志,2015,31(4):637-640.
[3]曹娟,赵彩霞,李海涛,等.甲状旁腺切除术治疗尿毒症继发性甲状旁腺功能亢进的疗效观察[J].实用临床医药杂志,2015,19(21):200-201.
[4]申伟,林敏娃,肖观清,等.中剂量骨化三醇冲击治疗血液透析患者重度甲状旁腺功能亢进的疗效分析[J].中国现代医学杂志,2015,25(1):102-105.
[5]史光彩,崔丽,郝丽,等.骨化三醇治疗维持性血液透析患者甲状旁腺功能亢进的临床疗效[J].中国现代医学杂志,2017,27(19):74-78.
[6]陈隽,王家东.继发性甲状旁腺机能亢进的诊疗进展[J].山东大学耳鼻喉眼学报,2016,30(2):36-39.
[7]程晨,王宁宁,查小明.不同外科术式治疗严重继发性甲状旁腺功能亢进的比较[J].中华肾脏病杂志,2015,31(4):314-320.
[8]殷德涛,余坤.继发性甲状旁腺功能亢进症的外科治疗[J].中国普通外科杂志,2016,25(5):631-634.
[9]徐方,沈渝,齐永灵.低钙透析液联合骨化三醇冲击治疗维持性血液透析合并继发性甲状旁腺功能亢进症疗效观察[J].海南医学,2016,27(14):2286-2288.
[10]任冰冰,卓莉,彭丽丽,等.继发性甲状旁腺功能亢进的超声诊断[J].中国超声医学杂志,2016,32(2):104-106.
[11]王赫男,郭增玉,王超民,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疗效与安全性观察[J].中国中西医结合肾病杂志,2016,17(7):625-626.
[12]王泰娜,徐斌,贾凤玉,等.帕立骨化醇治疗血液透析患者伴继发性甲状旁腺功能亢进[J].肾脏病与透析肾移植杂志,2015,24(1):1-5.
[13] Komaba H,Taniguchi M,Wada A,et al.Parathyroidectomy andsurvival among Japanese hemodialysis patients with secondary hyper-parathyroidism[J].Kidney International,2015,88(2):350-359.
[14]匡彬,方倩瑜,陈少敬,等.不同钙离子浓度透析液预防继发性甲状旁腺功能亢进效果比较[J].山东医药,2016,56(2):76-77.
[15]唐秀敏,陈建华,焦秀华,等.骨化三醇对非透析慢性肾脏病继发性甲状旁腺功能亢进患者血压的影响[J].中国综合临床,2015,31(6):541-544.
[16]付源,蔡汝超,章喜俊.低钙透析液联合活性维生素D治疗血液透析继发性甲状旁腺功能亢进临床观察[J].中国临床研究,2016,29(6):802-804.
[17]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.
[18] Berruti A,Sperone P,Fasolis G,et al.Pamidronate adminis-tration improves the secondary hyperparathyroidism due to“Bone hunger syndrome”in a patient with osteoblastic metasta-ses from prostate cancer[J].Prostate,2015,33(4):252-255.
[19]于永波,王玉奎.不同剂量骨化三醇对继发性甲状旁腺功能亢进症的远期疗效观察[J].实用临床医药杂志,2016,20(5):146-148.
[20]金磊,贾顺莲,高新英,等.西那卡塞联合小剂量骨化三醇对持续非卧床腹膜透析患者难治性继发性甲状旁腺功能亢进疗效观察研究[J].中国血液净化,2017,16(3):158-161.
[21]朱莉敏,程荣,路凌,等.超声引导下无水乙醇注射治疗难治性继发性甲状旁腺功能亢进的临床疗效分析[J].医学综述,2016,22(2):367-370.
[22]赵亚娟,黄兰,辛立升,等.骨化三醇冲击治疗对血液透析继发性甲状旁腺功能亢进症及FGF23的作用[J].河北医学,2016,22(11):1861-1863.
[23] Baón S,Rosillo M,Gómez A,et al.Effect of a monthly doseof calcidiol in improving vitamin D deficiency and secondary hy-perparathyroidism in HIV-infected patients[J].Endocrine,2015,49(2):528-537.
[24]黄庆龙,周健美.继发性甲状旁腺功能亢进症的治疗现状[J].安徽医学,2016,37(5):636-638.
[25]李雪梅,胡樱迪,吕彬,等.骨化三醇冲击治疗终末期肾脏病继发性甲状旁腺功能亢进疗效及安全性分析[J].中国中西医结合肾病杂志,2017,18(2):134-135.
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