帕立骨化醇治疗维持性血液透析患者继发性甲状旁腺功能亢进症的前瞻性研究

目的 观察帕立骨化醇治疗维持性血液透析患者继发性甲状旁腺功能亢进症（secondary hyperparathyroidism,SHPT）的疗效及安全性.方法 选择我科血液净化中心进行维持性血液透析治疗的13例患者,血全段甲状旁腺素（intact parathyroid hormone,iPTH）≥33 pmol/L,血钙水平＜2.55 mmol/L,钙磷乘积＜65,根据iPTH水平使用帕立骨化醇1～18 μg治疗,于每次透析治疗后给药,共观察12周.分别于治疗前及治疗后第2、4、6、8、10、12周测定患者的iPTH、血钙、血磷水平.结果 13例患者的血清iPTH水平在治疗后第2、4周已开始下降,但与治疗前相比差异无统计学意义.从治疗后第6周开始,iPTH水平与治疗前相比存在统计学差异（P＜0.05）,治疗后第12周时下降至（46.68±38.06） pmol/L,与治疗前（78.30±52.13） pmol/L比较,有统计学差异（P＜0.01）.治疗后第2、4周血钙水平升高,与治疗前比较有统计学差异（P＜0.05）,其中治疗后第4周时血钙水平升高尤为显著（P＜0.01）.经调整帕立骨化醇剂量后,治疗后第6周患者的血钙水平逐渐恢复正常并保持稳定,血磷、钙磷乘积水平在治疗前、后均无明显统计学差异.治疗过程中,患者耐受性良好,无相关不良反应的发生.结论 使用帕立骨化醇治疗维持性血液透析患者SHPT是有效、安全的.

Prospective clinical study of paricalcitol for treatment of secondary hyperparathyroidism in maintenance hemodialysis patients

Objective To evaluate the efficiency and security of paricalcitol in treating secondary hyperparathyroidism in maintenance hemodialysis（MHD）patients.Methods A total of 13 MHD patients with intact parathyroid hormone （iPTH） above 33 pmol/L,serum calcium less than 2.55mmol/L and calcium phosphorus product less than 65 were given paricalcitol （1～18μg） after each hemodialysis.The full course of the study was 12 weeks.Levels of serum iPTH,calcium and phosphorus were tested before and during the study period.Results Serum iPTH was decreased at week 2 and 4,but there was no significant difference as compared with the baseline.At week 6,iPTH was obviously decreased （P＜0.05）.Serum iPTH after 12 weeks was decreased from （78.30 ± 52.13） to （46.68 ±38.06）pmol/L （P＜0.01）.The serum calcium level was transiently increased at week 2 （P＜0.05）and 4 （P＜0.01）,and normalized from the week 6 after adjusting the dose of paricalcitol.The serum phosphorus and calcium phosphorus product levels were stable during the study period.No side effect was observed during the study.Conclusions The treatment of paricalcitol for secondary hyperparathyroidism in MHD was effective and safe.