论文部分内容阅读
目的探讨活性维生素D联合低钙透析对维持性血液透析继发性甲旁亢(SHPT)患者的疗效情况。方法根据全段甲状旁腺素(iPTH)水平将24例SHPT患者分为轻度(iPTH300～500pg/ml)、中度(iPTH500～1000pg/ml)和重度(iPTH>1000pg/ml)。在低钙透析(透析液钙浓度为1.25mmol/L)的基础上,轻度者予活性维生素D1～2μg,中度者予活性维生素D2～4μg,重度者予活性维生素D4～6μg,均每周2次,于透析后当晚睡前服用,连续观察12周。观察治疗前后患者血磷、钙磷乘积、iPTH及血清白蛋白(sAB)的变化。并根据iPTH水平,逐渐调整剂量,直至以最小剂量维持iPTH在目标值范围(150～300pg/ml)。结果所有患者均能完成疗程。30例患者治疗期间的血钙和血清白蛋白水平与治疗前比较,差异无统计学意义(P>0.05),钙磷乘积、iPTH水平均较治疗前降低(P<0.05)。结论活性维生素D联合低钙透析可有效控制维持性血液透析SHPT,安全可靠。
Objective To investigate the effect of active vitamin D combined with low calcium dialysis on maintenance hemodialysis patients with secondary hyperparathyroidism (SHPT). Methods Twenty-four SHPT patients were divided into mild (iPTH300 ~ 500pg / ml), moderate (iPTH500 ~ 1000pg / ml) and severe (iPTH> 1000pg / ml) according to the level of iPTH. On the basis of low calcium dialysis (dialysate calcium concentration of 1.25mmol / L), mild to active vitamin D1 ~ 2μg, moderate to active vitamin D2 ~ 4μg, severe to active vitamin D4 ~ 6μg, each 2 times a week, taken at bedtime after dialysis night, continuous observation of 12 weeks. Changes in serum phosphorus, calcium and phosphorus products, iPTH and serum albumin (sAB) were observed before and after treatment. And according to the level of iPTH, gradually adjust the dose until the minimum dose to maintain iPTH in the target value range (150 ~ 300pg / ml). Results All patients completed the course of treatment. There was no significant difference in serum calcium and serum albumin between the 30 patients before and after treatment (P> 0.05). The levels of calcium and phosphorus and iPTH were lower than those before treatment (P <0.05). Conclusion Active vitamin D combined with low calcium dialysis can effectively control the maintenance hemodialysis SHPT, safe and reliable.