降钙素及二膦酸盐治疗血液透析患者肾性骨病的长期疗效

目的 观察降钙素及二膦酸盐治疗维持性血液透析（MHD）患者肾性骨病的疗效及安全性。 方法 43例MHD患者按数字随机法分成A、B两组，均常规服用碳酸钙1.0 g tid、骨化三醇0.25 μg qd。A组加用降钙素20 U，皮下注射，每周3次（常规血液透析时使用）；B组在使用降钙素的同时加用二膦酸盐70 mg，口服，每周1次。在治疗前及治疗3、6、12个月时分别检测血全段甲状旁腺激素（PTH）、血钙、血磷、血清碱性磷酸酶（AKP）水平和腰椎、股骨颈骨密度，以及记录骨痛程度（采用视觉模拟疼痛评分，VAS）和不良反应。 结果 两组患者AKP和PTH水平比治疗前显著下降，治疗前和12个月时，A组AKP（U/L）为244.05±41.99和148.35±27.71；B组为245.60±40.86和143.40±28.03；A组PTH（ng/L）为697.5±119.7和267.4±45.9；B组为708.2±120.3和277.6±41.9；差异均有统计学意义（均P < 0.05）。两组血钙、血磷水平治疗前后差异无统计学意义。两组患者腰椎、股骨颈骨密度在治疗3、6个月时变化不明显，12个月时显著好转。与治疗前比较，12个月时A组腰椎骨密度（g/cm2）为1.202±0.251比1.062±0.223；B组为1.189±0.225比1.033±0.152；A组股骨颈骨密度（g/cm2）为1.067±0.095比0.993±0.108；B组为1.018 ±0.217比0.947±0.083, 均P ＜ 0.05。两组治疗前后主观评价骨痛程度减轻，VAS比治疗前显著下降，差异均有统计学意义（P < 0.05）。除B组个别患者有轻度消化道反应外，余无不良反应。 结论 降钙素及合用二膦酸盐可有效减少MHD患者的骨量丢失，降低PTH水平，改善临床症状，且无明显不良反应。单用降钙素与合用二膦酸盐的疗效无显著差异。

Long-term efficacy of calcitonin and bisphosphonates on renal osteopathy in maintenance hemodialysis patients

Objective To observe the efficacy of ealcitonin and bisphosphonates on renal osteopathy of maintenance hemodialysis (MHD)patients. Methods Forty-three MHD patients were raindomly divided into two groups: A group and B group. All the patients were routinely received oral calcium carbonate 1.0 g tid and calcitriol 0.25 μg qd. Calcitonin (20U) hypodermic injection was given three times a week additionally during hemodialysis in A group. Patients in B group received bisphosphonates 70 mg once a week based on the therapy of A group. Serum levels of intact parathyroid hormone (iPTH), calcium, phosphorus, alkaline phosphatase (AKP), bone mass density (BMD) of lumbar spine and femoral neck, and the degree of bone ache (visual analogue scale, VAS) were assessed before the therapy and 3, 6 and 12 months after treatment. The adverse reactions were recorded during treatment. Results The levels of AKP and iPTH in both two groups decreased significantly after treatment. The above values of pre-treatment and 12 months after treatment were as follows: AKP(U/L)of A group 244.05±41.99 and 148.35±27.71,of B group 245.60±40.86 and 143.40±28.03;PTH(ng/L) of A group 697.5±119.7 and 267.4±45.9,of B group 708.2±120.3 and 277.6±41.9 (all P<0.05). While the levels of calcium and phosphorus did not change obviously during treatment (P>0.05). BMD was not improved at 3, 6 mouths and became better at 12 mouths after treatment. As compared to pre-treatment, BMD of lumbar spine(g/cm2) in A group was 1.062±0.223 vs 1.202±0.251 ,in B group 1.033±0.152 vs 1.189±0.225; BMD of femoral neck (g/cm2)in A group was 0.993±0.108 vs 1.067±0.095,in B group 0.947±0.083 vs 1.018 ±0.217 (all P<0.05). The scores of VAS also decreased significantly at 3, 6, 12 months after treatment(P<0.05). No severe adverse reaction was found during the treatment. Conclusions Utilization of calcitonin and combination with bisphosphonates during bemodialysis can effectively preserve the BMD and prevent bone loss in MHD patients and is well tolerated. No significant difference of therapeutic effect is observed between using ealcitonin or combination with bisphosphonates.