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的疗效观察

目的观察帕立骨化醇对维持性血液透析患者继发性甲状旁腺功能亢进症的治疗效果。方法选择2018年7月至2019年7月对非选择性维生素D受体激动剂(VDRA)疗效不佳或不能耐受拟钙剂或不愿手术治疗的继发性甲状旁腺功能亢进(SHPT)的维持性血液透析患者56例,根据血液全段甲状旁腺素(iPTH)水平将所有患者分为三个组别:A组(300 pg/mL≤iPTH<600 pg/mL)、B组(600 pg/mL≤iPTH<800 pg/mL)、C组(iPTH≥800 pg/mL)。根据体重给予不同剂量的静脉帕立骨化醇注射液,分别检测患者治疗前、初始使用1个月以及达到帕立骨化醇维持剂量时,iPTH、血钙、血磷、钙磷乘积的变化情况。结果患者骨痛、瘙痒、疲乏等症状明显改善。所有患者初始治疗1个月,iPTH达标率为51.8%(29/56),达到帕立骨化醇注射液维持治疗剂量百分比为57.1%(32/56)。患者初始治疗1个月与治疗前相比,iPTH水平显著下降(718.76±457.56)pg/mL vs.(956.68±375.61)pg/mL,P<0.001],血钙、血磷以及钙磷乘积无明显改变(2.28±0.23)mmol/L vs.(2.23±0.27)mmol/L,(2.15±0.49)mmol/L vs.(2.29±0.48)mmol/L,(58.49±17.71)mg^2/dl2 vs.(62.90±13.93)mg^2/dl2,P>0.05]。进入维持治疗阶段的患者,维持治疗与初始治疗相比,iPTH水平仍有下降趋势,但差异无统计学意义(424.82±221.23)pg/mL vs.(517.55±325.77)pg/mL,P>0.05],血钙、血磷以及钙磷乘积比较差异无统计学意义(2.33±0.20)mmol/L vs.(2.31±0.24)mmol/L,(2.13±0.44)mmol/L vs.(2.00±0.42)mmol/L,(61.24±12.25)mg^2/dl2 vs.(55.76±15.66)mg^2/dl2,P>0.05]。结论帕立骨化醇对非选择性VDRA疗效不佳或不能耐受拟钙剂或不愿手术治疗的维持性血液透析患者SHPT有较好的疗效,明显缓解患者骨痛、瘙痒、疲乏等症状,显著降低iPTH水平,且不增加高钙血症的发生风险。

Clinical effect of paricalcitol on secondary hyperparathyroidism in maintenance hemodialysis patients

Objective  To observe the effect of paricalcitol on secondary hyperparathyroidism(SHPT) in maintenance hemodialysis patients. Methods  From July 2018 to July 2019, 56 SHPT maintenance hemodialysis patients with poor efficacy of non selective vitamin D receptor activator(VDRA) or intolerance to calcimimetics or unwilling to operate from several hospitals in Hunan province were selected. According to the level of serum intact parathyroid hormone (iPTH), all patients were divided into three groups, group A(300 pg/mL≤iPTH＜600 pg/mL), group B(600 pg/mL≤iPTH 800 pg/mL) and group C(iPTH≥800 pg/mL). Patients received different doses of intravenous paricalcitol injection based on their body weight. The levels of iPTH, blood calcium, blood phosphorus and calcium phosphorus product before treatment, initial treatment for 1 month, and when reaching the maintenance dose of paricalcitol were measured. Results  Patients' symptoms such as bone pain, itching, fatigue improved. After 1 month of initial treatment, the iPTH compliance rate of all patients was 51.8%(29/56), and the percentage of patients reaching the maintenance dose of paricalcitol was 57.1%(32/56). Serum iPTH at 1month of initial treatment was significantly decreased compared with prior treatment(718.76±457.56) pg/mL vs. (956.68±375.61)pg/mL,P<0.001]. There was no significant change in serum calcium, serum phosphorus and calcium phosphorus product before and after treatment(2.28±0.23) mmol/L vs.(2.23±0.27)mmol/L,(2.15±0.49)mmol/L vs.(2.29±0.48)mmol/L, (58.49±17.71)mg²/dl² vs.(62.90±13.93)mg²/dl²,P>0.05]. Compared with initial treatment, serum iPTH of patients entering maintenance therapy still declined, but the difference was not statistically significant(424.82±221.23) pg/mL vs.(517.55±325.77)pg/mL,P>0.05]. There was no significant change in serum calcium, serum phosphorus and calcium phosphorus product between initial treatment with maintenance treatment(2.33±0.20)mmol/L vs.(2.31±0.24)mmol/L, (2.13±0.44)mmol/L vs.(2.00±0.42)mmol/L, (61.24±12.25)mg²/dl² vs.(55.76±15.66)mg²/dl²,P>0.05]. Conclusions  Paricalcitol treatment has good curative effect on SHPT in maintenance hemodialysis patients with poor efficacy with poor efficacy of non selective VDRA or intolerance to calcimimetics or unwilling to operate, which can relieve the symptoms of bone pain, itching, fatigue, reduce the level of serum iPTH significantly, and dose not increase the risk of hypercalcemia.