西那卡塞对维持性血液透析继发性甲状旁腺功能亢进患者FGF-23的影响

目的 研究西那卡塞对维持性血液透析继发性甲状旁腺功能亢进患者FGF-23的影响。方法 选取2015年1月~2016年10月在天津市第一中心医院血液净化中心行维持性血液透析治疗合并继发性甲状旁腺功能亢进的患者，按入院顺序随机分为观察组及对照组，对照组40例，给予骨化三醇治疗，观察组39例，给予对照组患者相同的骨化三醇治疗的基础上，再加用盐酸西那卡塞片，两组均连续治疗3个月。监测两组治疗前后的尿素氮、血肌酐、KT/V、血清钙、血清磷、碱性磷酸酶、钙磷乘积、全段甲状旁腺激素 (iPTH)及血清FGF-23。结果 治疗后，两组患者的BUN、SCr和Kt/V 较治疗前,差异无统计学意义（P＞0.05）；血清钙观察组治疗后低于对照组（P＜0.05），对照组治疗前后，差异无统计学意义（P＞0.05）；两组血清磷、ALP、钙磷乘积、iPTH、FGF-23治疗后降低，且治疗后观察组优于对照组，差异有统计学意义 (P<0.05)。结论 西那卡塞对于维持性血液透析合并继发性甲状旁腺功能亢进的患者能够降低甲状旁腺激素及FGF-23水平，缩小甲状旁腺体积。

Effect of Cinacalcet on FGF-23 in Patients with Secondary Hyperparathyroidism during Maintenance Hemodialysis

Abstract:Objective To study the effect of Cinacalcet on FGF-23 in patients with secondary hyperparathyroidism during maintenance hemodialysis.Methods Patients who underwent maintenance hemodialysis treatment with secondary hyperparathyroidism at the Blood Purification Center of Tianjin First Central Hospital from January 2015 to October 2016 were randomly divided into observation group and control group according to the order of admission.In the control group,40 patients were treated with calcitriol, and 39 patients in the observation group were given the same calcitriol treatment as the control group,plus cinacalcet hydrochloride tablets.The two groups were treated continuously for 3 months.Urea nitrogen,serum creatinine,KT/V,serum calcium,serum phosphorus, alkaline phosphatase,calcium phosphate,total parathyroid hormone(iPTH)and serum FGF-23 were monitored before and after treatment.Results After treatment,there was no significant difference in BUN,SCr and Kt/V between the two groups before treatment (P>0.05),and the serum calcium observation group was lower than the control group after treatment(P<0.05),the difference was not statistically significant before and after treatment in the control group(P>0.05);the two groups decreased after the treatment of serum phosphorus,ALP,calcium and phosphorus product,iPTH and FGF-23,and the observation group was better than the control group after treatment,the difference was statistically significant(P<0.05).Conclusion Cinacalcet can reduce parathyroid hormone and FGF-23 levels and reduce the volume of parathyroid glands in patients with maintenance hemodialysis and secondary hyperparathyroidism.