拟钙剂与降钙素治疗继发性甲旁亢合并高钙血症疗效比较

目的 探讨拟钙剂与降钙素治疗继发性甲状旁腺功能亢进症(SHPT)合并高钙血症患者的异同及优势.方法 收集2012年6月至2016年6月期间我院肾内科使用活性维生素D冲击治疗SHPT合并高钙血症的维持性血液透析患者30例.根据随机数字表法分成两组,每组15例.观察组在使用活性维生素D基础上联合拟钙剂口服,对照组则采用活性维生素D口服、降钙素肌注的方法,疗程均为3个月.治疗结束后检测并比较两组患者的血钙、血磷、甲状旁腺激素、1型胶原N-端前肽(P1PN)、1型胶原交联C-末端肽(CTX-1)、骨型碱性磷酸酶(NBAP)水平;双能X线骨密度仪测量两组患者的骨密度值(BMD),计算两组转移性钙化评分(CS),并进行比较.结果 治疗后,观察组患者的IPTH水平为(306.13±89.35)pg/mL,明显低于对照组的(376.73±46.46)pg/mL,差异有统计学意义(P<0.05);对照组患者的P1PN、CTX-1、NBAP水平分别为(0.36±0.08)pg/mL、(62.66±12.50)pg/mL、(74.73±18.56)U/L,明显低于观察组的(0.44±0.10)pg/mL、(74.06±14.58)pg/mL、(104.67±44.23)U/L,差异均有统计学意义(P<0.05);两组患者的CS、BMD比较差异均无统计学意义(P>0.05).结论 拟钙剂及降钙素在治疗SHPT合并高钙血症患者方面各具优势,两者均能有效降低血钙,拟钙剂在降低iPTH水平、减少全身转移性钙化上优势显著,降钙素在治疗肾性骨病和改善骨代谢方面效果更好.

Comparative study of calcimimetics and calcitonin in the treatment of the patients with secondary hyperparathyroidism combined with hypercalcemia

Objective To explore the similarities and differences between calcimimetics and calcitonin in the treatment of secondary hyperparathyroidism (SHPT) combined with hypercalcemia. Methods A total of 30 patients with SHPT combined with hypercalcemiain, who admitted to our hospital and received the treatment of active vitamin D from June 2012 to June 2016, were selected and randomly divided into the two groups according to random number ta-ble method, with 15 cases in each group. The observation group received active vitamin D with calcimimetics, and the control group was treated with active vitamin D with calcitonin. The treatment course of the two groups were 30 days. After the treatment, the levels of serum calcium, blood phosphorus, intact parathyroid hormone (IPTH), N-terminal pro-peptide of type I collagen (P1NP), C-terminal cross-linking telopeptide of type I collagen (CTX-1), neonatal bone alka-line phosphatase (NBAP) were detected and compared. The bone mineral density (BMD) of the two groups was mea-sured by dual energy X-ray absorptiometry, and the metastatic calcification scores (CS) of the two groups were calculat-ed and compared. Results The level of IPTH in the observation group was (306.13±89.35) pg/mL, which was signifi-cantly lower than (376.73 ± 46.46) pg/mL in the control group (P<0.05). PIPN, CTX, BAP in the control group were (0.36±0.08) pg/mL, (62.66±12.50) pg/mL, (74.73±18.56) U/L, which were significantly lower than (0.44±0.10) pg/mL, (74.06 ± 14.58) pg/mL, (104.67 ± 44.23) U/L in the observation group (P<0.05). There was no significant difference be-tween the two groups in CS and BMD (P>0.05). Conclusion Calcimimetics and calcitonin have their own advantages in the treatment of SHPT with hypercalcemia. They both can effectively reduce the serum calcium. Calcimimetics has better performance in reducing the level of IPTH and calcification, and calcitonin has better performance in the treatment of renal bone disease and bone metabolism.