个体化护理措施对血液透析患者甲状旁腺功能亢进冲击治疗效果的影响

目的：探讨个体化护理措施对维持性血液透析患者继发性甲状旁腺功能亢进应用骨化三醇冲击治疗效果的影响。方法选取2011年10月—2013年10月进行血液透析继发甲状旁腺功能亢进患者60例,按照随机数字表法将其随机分为对照组和观察组各30例,对照组接受常规护理指导,观察组患者接受个体化认知干预、饮食干预等个体化护理措施。干预后6个月评价患者服药依从性、饮食情况、血钙、血磷、血清白蛋白及全段甲状旁腺激素（ iPTH）含量。结果干预后观察组患者服药依从性良好20例,一般8例,差2例,优于对照组,差异有统计学意义（ Z＝2．170,P＜0．05）。观察组饮食达标率83．33％（25／30）,高于对照组的60．00％（18／30）,差异有统计学意义（χ2＝4．022,P＜0．05）。两组患者血钙含量比较差异无统计学意义,观察组血磷浓度、钙磷乘积、iPTH含量与对照组比较差异有统计学意义（P＜0．05）。结论个体化护理措施在甲状旁腺功能亢进应用骨化三醇冲击治疗中起到了积极作用。     

慢性肾功能衰竭肾性骨病患者采取骨化三醇治疗的疗效观察

目的：关于将骨化三醇用于治疗慢性肾功能衰竭肾性骨病患者所取得的疗效进行分析探讨。方法：选取在笔者所在医院接受治疗的66例慢性肾功能衰竭肾性骨病患者,将患者随机分成两组。对照组患者进行常规治疗。实验组患者在进行常规治疗的同时采用骨化三醇治疗。比较并观察两组患者治疗后各指标的变化情况,以及观察治疗后两组患者出现不良反应的情况。结果：两组患者进行不同方法治疗后,实验组血清钙（2．46±O．39）mmol／L明显高于对照组（1．99±O．37）mmol／L,比较差异有统计学意义（P〈O．05）。实验组血磷、碱性磷酸酶、尿素氮、肌酐明显低于对照组,比较差异有统计学意义（P〈O．05）。结论：采用骨化三醇用于治疗慢性肾功能衰竭肾性骨病比常规治疗的效果好,可以加快钙的吸收,降低患者体内血磷、碱性磷酸酶、尿素氮、肌酐水平,可有效改善肾性骨病,且不良反应发生率低,在If蠡床上可以广泛运用。     

Effect of Rocaltrol on Bone Mass in Patients with Pulmonary Disease Treated with Corticosteroids

The aim of this study was to evaluate the effect of calcitriol on bone mass in patients with corticosteroid induced osteoporosis. Thirty-seven patients (26 females, 11 males, mean age 66.4 years) with pulmonary disease under long-term treatment with corticosteroids (5–10 mg prednisolone daily) and osteopenia/osteoporosis verified by dual-energy x-ray absorptiometry (DEXA) measurement were enrolled into the study. Rocaltrol was prescribed to 30/37 of the patients, the rest of the patients (6 females, 1 male) served as controls. In the treatment group, there was a slight increase of bone mass in the hip and lumbar vertebrae (L1–L4), whereas the control group showed a decrease of bone mass (change rate of bone mass in patients +0.8% and +1.0%, respectively, vs. –1.9% and –0.3%, respectively, in the control group). The preliminary results of our study suggest a beneficial role for the treatment of corticosteroid induced osteoporosis with Rocaltrol, which is well-tolerated by patients and cost-efficient in patient management.     

绝经后妇女骨密度与血清1，25-（OH）2D3，25-OHD3浓度关系的研究

目的：研究绝经后妇女无优势手臂骨密度与血清1,25-（OH）2D3,25-OHD3含量的关系。方法：采用定量超声骨量分析系统（QUS）测量82例绝经后妇女无优势前臂远端骨密度（BMD）以诊断骨质疏松,采用放射免疫法（RIA）和ELISA检测骨质疏松组和骨量正常组妇女血清中1,25-（OH）2D3,25-OHD3水平。结果：绝经后骨质疏松组妇女血清1,25-（OH）2D3,25-OHD3含量分别为（26.97±6.78）pg/ml和（34.75±12.62）nmol/L,骨量正常组分别为（34.75±12.62）pg/ml和（42.03±12.63）nmol/L,骨质疏松妇女血清1,25-（OH）2D3、25-OHD3含量明显低于骨量正常组（P〈0.01）。绝经后妇女无优势前臂骨密度与血清1,25-（OH）2D3含量存在明显相关性（r=0.387,P=0.001）,25-OHD3含量与前臂骨密度也存在相关性。结论：血清1,25-（OH）2D3水平与无优势前臂骨密度明显相关,是绝经后妇女骨量降低的重要原因之一。     

Monocyte fructose 1,6-bisphosphatase and cytidine deaminase enzyme activities: potential pharmacodynamic measures of calcitriol effects in cancer patients

Purpose: To determine, in peripheral blood monocytes (PBM), whether the enzymatic activities of fructose 1,6-bisphosphatase (FBPase), cytidine deaminase (CDDase) and 24-hydroxylase (CYP24), enzymes regulated by calcitriol are useful pharmacodynamic (PD) measures of calcitriol effects in cancer patients. Methods: Cancer patients enrolled in a phase I clinical trial of calcitriol and carboplatin were studied. Baseline and calcitriol-induced changes in FBPase, CDDase and CYP24 activities were measured in PBM collected before, 6, 24, and 48 h after administration of calcitriol, prior to carboplatin, in doses ranging from 4 to 11 μg daily for 3 consecutive days (QD×3). Normal FBPase, CYP24 and CDDase activities were measured in PBM from untreated healthy volunteers. Results: Baseline activities in PBM from cancer patients and healthy volunteers were (median and range): 1.0 (0.0–43.5) and 4.4 (3.1– 8.2) nmol/min/mg protein for FBPase (P = 0.002); 2.5 (0.9–9.3) and 0.8 (0.4–2.0) fmol/h/10⁶ cells for CYP24 (P = 0.016), and 5.6 (2.5–22.3) and 6.6 (1.1–47.4) nmol/min/mg protein for CDDase (P > 0.05), respectively. All calcitriol doses achieved peak serum calcitriol levels > ×3 the physiological levels, increased cancer patient PBM FBPase activity to normal levels and decreased CDDase activity to undetectable levels within 48 h, with no significant change in CYP24 activity. These enzyme activity changes were not associated with hypercalcemia. Conclusions: Calcitriol treatment-induced increase in FBPase and decrease in CDDase activities in cancer patient PBM are potential early and sensitive non-hypercalcemia PD measures of calcitriol effects.     

骨化三醇联合仙灵骨葆治疗女性骨质疏松症的临床研究

目的通过骨化三醇联合仙灵骨葆、阿仑膦酸钠分别治疗女性症状型骨质疏松症患者,对比骨密度、疼痛感觉、碱性磷酸酶指标改善情况观察其疗效,考察骨化三醇联合仙灵骨葆对骨质疏松症具体临床效果,提供临床参考。方法选取河北省徐水县原发性骨质疏松症女性患者90人,随机分为两组,每组45人,分别使用骨化三醇胶丸＋仙灵骨葆胶囊（A组）,阿仑膦酸钠（B组）治疗6个月,对比骨密度、疼痛感觉、碱性磷酸酶指标改善情况。结果A组完成治疗38人,B组完成治疗36人;两组治疗6个月后骨密度、疼痛感觉、碱性磷酸酶指标均明显改善（P〈0．05）,两组比较差异无统计学意义（P〉0．05）,两组个别患者出现药物不良反应,均程度较轻,停药后症状可逆,但是联合用药组有更好的患者依从性。结论骨化三醇胶丸联合仙灵骨葆胶囊治疗女性骨质疏松症有良好疗效。     

钙三醇抑制肾间质成纤维细胞的活化

目的 通过观察钙三醇对肾间质成纤维细胞增殖和凋亡的影响，及其对转化生长因子（TGF）β1诱导的成纤维细胞转分化和细胞外基质(ECM)合成的干预作用，旨在探讨钙三醇抗肾间质纤维化的潜在效应及相关机制。 方法 体外培养大鼠肾间质成纤维细胞NRK-49F，分别以不同浓度TGF-β1（1、2、5和10 μg/L）和（或）不同浓度钙三醇（10－4、10－5、10－6、10－7、和10－8 mmol/L）进行干扰。MTT法观察细胞增殖情况；流式细胞术分析细胞周期和细胞凋亡改变；实时定量PCR和Western印迹法分别检测细胞内α平滑肌肌动蛋白（α-SMA）、结缔组织生成因子（CTGF）及纤连蛋白（FN）的mRNA和蛋白表达。 结果 钙三醇能明显抑制正常和TGF-β1（5 μg/L）诱导的NRK-49F细胞增殖（P < 0.01）。经不同浓度钙三醇（10－4、10－5、10－6、10－7、和10－8 mmol/L）作用48 h后，NRK-49F细胞G2/S期细胞比例较TGF-β1刺激组均明显减少（分别为25.88%、21.81%、21.73%、23.28%、23.61%比27.42%，均P < 0.05），但对细胞凋亡无明显影响。NRK-49F细胞经TGF-β1刺激后，其α-SMA、CTGF、FN mRNA表达量显著上升，并在TGF-β1 1~5 μg/L的范围内呈剂量依赖效应。钙三醇能明显抑制TGF-β1诱导的α-SMA、CTGF、FN mRNA表达上调（均P < 0.05），而不同钙三醇浓度干预组之间差异无统计学意义。钙三醇能显著降低TGF-β1诱导的α-SMA和FN蛋白表达（P < 0.05）。 结论 钙三醇可通过G1期停滞抑制大鼠肾间质成纤维细胞增殖，但不影响凋亡。钙三醇具有拮抗 TGF-β1致肾间质纤维化的潜在作用。     

Paricalcitol versus calcitriol treatment for hyperparathyroidism in pediatric hemodialysis patients

Secondary hyperparathyroidism (SHPT) remains a treatment dilemma in pediatric dialysis patients. Recent experience with paricalcitol (P), a vitamin D analogue, in adults with SHPT has shown equal efficacy and improved survival compared to traditional treatment with calcitriol (C). We present our experience with (C) compared to (P) treatment in our pediatric dialysis patients with SHPT. Twenty-one patients (mean age 11.5±5 years) with SHPT (intact parathyroid hormone (iPTH) averaging 1,228±496 pg/ml) were studied. Seventeen received (C) followed by (P); while an additional four were treated with either (C=1) or (P=3) alone. After 26±8 weeks, average percent (%) decrease in iPTH was similar with (C) and (P) (−60.4±34% versus −65.4±28%, respectively; p=0.6). In the (P) group, the effective dose in children was greater than in adult trials based on kilogram weight. Episodes of hypercalcemia between the treatment groups were not different. However, episodes of elevated calcium × phosphorus product (Ca×P)≥70 mg²/dl² occurred more frequently in the (C) group (odds ratio=1.5; p=0.01). Paricalcitol appears to be safe and effective in pediatric patients. Data suggest that dosing should be gauged according to degree of SHPT. This should serve as impetus for future pharmacokinetic studies in pediatric dialysis patients.     

Bone Mass and Markers of Bone and Calcium Metabolism in Postmenopausal Women Treated with 1,25-Dihydroxyvitamin D (Calcitriol) for Four Years

To evaluate the long-term effect of calcitriol treatment on bone mineral density (BMD) of the femoral neck and lumbar spine and the parameters of calcium and bone metabolism in elderly women, 55 healthy, postmenopausal women, all aged 66 years, were enrolled in the study. Eighteen started a 4-year supplementation with 0.5 μg of calcitriol daily and 37 served as controls. Calcium intake of all the subjects was adjusted to 800 mg daily. In 4 years femoral neck BMD increased by 3.0% in the calcitriol group, but decreased by 1.6% in the control group (P= 0.009). The respective changes in lumbar spine BMD were +2.3% and +0.9% (P= 0.067). Two years' treatment with calcitriol increased the intestinal absorption of strontium by 57% (P < 0.001), doubled the urinary excretion of calcium (P < 0.001), and decreased the mean parathyroid hormone (PTH) level by 32% (P < 0.01). In the calcitriol group the marker of bone formation, serum osteocalcin, decreased by 27% (P < 0.01), and the marker of bone resorption, serum C-telopeptide of type I collagen (CTx), by 33% (P= 0.05) after 2 years. In two subjects the calcitriol dose had to be reduced because of hypercalciuria. We conclude that calcitriol treatment increases bone mass at the femoral neck and lumbar spine, the increases being maintained for up to 4 years. The gain in bone mass results from reduced bone turnover which is partly a consequence of the enhanced intestinal absorption of calcium and suppressed serum PTH levels. Received: 8 January 1999 / Accepted: 29 February 2000