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目的观察西那卡塞辅助治疗血液透析继发性甲状旁腺功能亢进(SHPT)患者的临床疗效及安全性。方法选取2013年3月—2015年12月湖北省黄石市爱康医院肾内科确诊且住院治疗的血液透析后SHPT患者98例作为研究对象,采用单盲数字随机法分为观察组49例(西那卡塞联合骨化三醇冲击治疗)和对照组49例(规范骨化三醇冲击治疗),对比分析2组治疗3个月后临床疗效、实验室指标[血钙、血磷、钙磷乘积、甲状旁腺激素(iPTH)]、甲状旁腺体积及不良反应。结果观察组总有效率为95.92%(47/49)高于对照组的81.64%(40/49)(χ~2=5.018,P=0.25);治疗3个月后,对照组的血清钙为(2.29±0.26)mmol/L,钙磷乘积为(45.98±6.27)mg/dl,观察组的血清钙为(2.61±0.27)mmol/L,钙磷乘积为(47.65±6.41)mg/dl,观察组较对照组明显升高(t=2.786、6.178,P<0.05);全段甲状旁腺激素观察组为(129.45±25.87)pg/ml、血磷为(1.03±0.06)mmol/L,对照组为(307.25±36.45)pg/ml、(1.65±0.08)mmol/L,观察组较对照组明显降低(t=10.986,P=0.000;t=3.015,P=0.034);治疗后2组甲状旁腺体积均明显缩小,且观察组明显小于对照组[(59.97±6.41)mm~3 vs.(129.37±8.58)mm~3,t=19.846,P=0.000];观察组药物不良反应率为4.08%(2/49),低于对照组的18.37%(9/49)差异有统计学意义(χ~2=5.018,P=0.025)。结论西那卡塞辅助治疗血液透析后SHPT可促进iPTH降低及甲状旁腺体积缩小,不良反应少,值得临床推广。
Objective To observe the clinical efficacy and safety of cinacalcet in adjuvant treatment of hemodialysis patients with secondary hyperparathyroidism (SHPT). Methods From March 2013 to December 2015, 98 patients with post-hemodialysis SHPT diagnosed and hospitalized in Department of Nephrology, Icahn Hospital, Huangshi City, Hubei Province were selected as the study subjects. The subjects were divided into observation group (49 cases) Nakasone combined with calcitriol shock treatment) and control group (n = 49) (standardized calcitriol treatment). The clinical effects of the two groups were compared after 3 months of treatment. The laboratory parameters [serum calcium, phosphorus, calcium Product, parathyroid hormone (iPTH)], parathyroid volume, and adverse reactions. Results The total effective rate in the observation group was 95.92% (47/49), which was significantly higher than that in the control group (81.64%, 40/49) (χ ~ 2 = 5.018, P = 0.25) (2.29 ± 0.26) mmol / L, and the product of calcium and phosphorus was (45.98 ± 6.27) mg / dl. The serum calcium was (2.61 ± 0.27) mmol / L and the product of calcium and phosphorus was (47.65 ± 6.41) (129.45 ± 25.87) pg / ml in the observation group and 1.03 ± 0.06 mmol / L in the observation group, compared with the control group (t = 2.786,6.178, P <0.05) (307.25 ± 36.45) pg / ml and (1.65 ± 0.08) mmol / L respectively in the observation group and the control group (t = 10.986, P = 0.000; t = 3.015, P = 0.034) The volume of parathyroid glands were significantly reduced, and the observation group was significantly smaller than the control group (59.97 ± 6.41) mm ~ 3 (129.37 ± 8.58) mm ~ 3, t = 19.846, P = 0.000]; observation group adverse drug reaction rate The difference was statistically significant (χ ~ 2 = 5.018, P = 0.025), which was 4.08% (2/49) in the control group and 18.37% (9/49) in the control group. Conclusion Cinacalcet adjuvant treatment of hemodialysis SHPT can promote iPTH reduction and parathyroid volume reduction, fewer adverse reactions, worthy of clinical promotion.