西那卡塞治疗血液透析患者继发性甲状旁腺功能亢进的临床研究

目的 探讨西那卡塞在血液透析继发性甲状旁腺功能亢进患者中的应用效果.方法 98例血液透析治疗后继发性甲状旁腺功能亢进症(SHPT)患者随机分为观察组和对照组,每组49例.对照组给予磷结合剂、维生素D类似物等常规治疗,观察组在对照组基础上给予西那卡塞治疗,对比2组患者临床疗效及血钙、血磷、iPTH水平、ALP水平变化及肾功能情况.结果 观察组总有效率为87.8%显著高于对照组的67.3%(P<0.05);2组患者治疗后血钙均显著升高(P<0.01),血磷、ALP、iPTH均显著降低(P<0.01),且治疗后观察组显著优于对照组(P<0.01);2组患者治疗前后BUN、Scr、KT/V差异无统计学意义(P>0.05);2组甲状旁腺治疗后均较治疗前显著减小(P<0.01),且观察组治疗后显著小于对照组(P<0.01);对照组不良反应发生率为40.8%显著高于对照组的12.2%(P<0.05).结论 西那卡塞用于血液透析患者继发SHPT具有理想疗效,能够显著降低甲状旁腺激素,同时缩小甲状旁腺体积,且不良反应少,安全性高,值得临床推广.

Clinical study on cinacalcet in treatment of secondary hyperparathyroidism in hemodialysis patients

Objective To investigate the clinical effects of cinacalcet on secondary hyperparathyroidism (SHPT) in patients receiving hemodialysis.Methods Ninety-eight hemodialysis patients with SHPT were divided into observation group (n=49) and control group (n=49).The patients in control group were treated by conventional therapy including phosphate binding agent and vitamin D analogue,however,the patients in observation group,on the basis of control group,were given oral cinacalcet,then the clinical effects,the serum levels of calcium,phosphorus,iPTH,ALP and renal function were observed and compared between the two groups.Results The effective rate in the observation group was 87.8%,which was significantly higher than that (67.3%) in control group (P <0.05). After treatment the serum levels of calcium were significantly increased in both groups (P<0.01),but the serum levels of phosphorus,ALP and iPTH were significantly decreased (P<0.01),moreover observation group was superior to control group(P<0.01).There were no significantly differences in BUN, Scr,and KT/V between two groups (P>0.05).The volume of parathyroid glands after treatment was obviously smaller than that before treatment in both groups (P<0.01), moreover,which in observation group was significantly smaller than that in control group (P<0.01). The incidence rate of adverse reactions in control group was 40.8%,which was significantly higher than that (14.3%) in observation group (P <0.01).Conclusion The cinacalcet has satisfactory therapeutic effects on SHPT in hemodialysis patients,which can effectively reduce the levels of parathyroid hormone,at the same time,which can decrease parathyroid gland volume,with less adverse reactions and higher fafety, therefor, which is worth using widely in clinical practice.