长期血液透析继发性甲旁亢患者骨化三醇冲击治疗的效果观察

目的观察骨化三醇对长期血液透析患者合并中度继发性甲旁亢(SHPT,iPTH500～1000pg/ml)进行冲击治疗的疗效和安全性。方法将40例符合标准的患者随机分为对照组和观察组各20例,所有患者在治疗期间未服用含钙制剂,给予钙浓度1.25mmol/L的碳酸氢盐透析液进行血液透析及相关治疗,对照组骨化三醇常规剂量口服,观察组骨化三醇冲击剂量口服,比较两组治疗前后以及组间血Ca、P、Ca×P、iPTH变化。结果对照组治疗前后血Ca、P、Ca×P、iPTH均无变化(P>0.05);观察组治疗后与自身治疗前比较血Ca、Ca×P明显上升(P<0.05),iPTH明显下降(P<0.01),血P无明显变化(P>0.05);观察组治疗后血Ca和Ca×P升高、iPTH下降,观察组与对照组治后比较差异显著(P<0.05或P<0.01),两组治疗后血P比较无变化(P>0.05)。结论对于长期透析当合并中度SHPT的患者,骨化三醇冲击剂量口服的疗效优于常规剂量口服,起效迅速,安全可行。

Effect of calcitriol pulse therapy in long-term hemodialysis patients with secondary hyperparathyroidism

Objective To observe the efficacy and safety of calcitriol pulse therapy in long-term hemodialysis pa- tients with secondary hyperparathyroidism. Methods 40 cases of long-term hemodialysis patients with secondary hyper- parathyroidism were selected（serum parathyroid hormone levels between 500pg/mL-1000 pg/mL）,and were randomly di- vided into pulse group and routine treatment group. Results There was no significant differences between values of calci- um,phosphorus, Ca）〈 P,and iPTH before and after treatment in routine group（P~0.05）. There was significant differ- enees between values of calcium, CaX P（P〈0.05）, （P〉0.05）and iPTH（P〈0.01） before treatment and after in pulse group, and no difference between values of phosphorus. There was significant differences between values of calcium, Ca X P（P〈0.05） ,（P〉0.05）and iPTH（P〈0.01） after treatment in pulse group and routine group. Conclusion Calcitriol pulse therapy in long-term hemodialysis patients with secondary hyperparathyroidism was more valuable than routine therapy.