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目的观察骨化三醇冲击联合碳酸镧、碳酸钙对维持性血液透析患者继发性甲状旁腺功能亢进的疗效。方法 31例血液透析患者,根据全段甲状旁腺激素浓度分为两个亚组,iPTH为300~600 pg/ml为A1组(18例),iPTH>600 pg/ml为A2组(13例)。分别给予口服骨化三醇,均于透析日睡前给予,另透析日口服碳酸镧,非透析日口服碳酸钙。分别测定治疗前及后全段甲状旁腺素(iPTH)、血钙(SCa)、血磷(SP)、磷乘积(Ca×P)和碱性磷酸酶(AKP)。结果冲击治疗后,iPTH明显降低,血钙、血磷及钙磷乘积无明显升高,患者临床症状改善,达标率高,差异有统计学意义(P<0.05)。结论透析后当日口服骨化三醇冲击并口服碳酸镧、非透析日口服碳酸钙治疗对于继发性甲状旁腺功能亢进疗效显著,值得推广。
Objective To observe the effect of calcitriol shock combined with lanthanum carbonate and calcium carbonate on secondary hyperparathyroidism in maintenance hemodialysis patients. Methods Thirty-one hemodialysis patients were divided into two subgroups according to the total parathyroid hormone concentration: iPTH 300-600 pg / ml for group A1 (n = 18), iPTH> 600 pg / ml for group A2 (n = 13) ). Oral calcitriol were given, were given before bedtime on dialysis day, another dialysis day oral lanthanum carbonate, non-dialysis oral calcium carbonate. The levels of iPTH, SCa, SP, Ca × P and AKP were measured before and after treatment. Results After shock treatment, iPTH was significantly decreased. There was no significant increase in serum calcium, phosphorus, calcium and phosphorus, and the clinical symptoms were improved and the compliance rate was high. The difference was statistically significant (P <0.05). Conclusions On the day after dialysis, oral calcitriol was administered orally and lanthanum carbonate was administered orally. Non-dialysis day oral calcium carbonate had a significant curative effect on secondary hyperparathyroidism and was worth promoting.