CAJ | 학술논문

目的：比较骨化三醇常规口服与冲击疗法治疗维持血液透析继发甲状旁腺功能亢进（简称继发性甲旁亢）的临床疗效。方法选取2011年2月-2013年4月本院收治的100例继发甲旁亢的维持性血液透析患者，将其按照全段甲状旁腺素（ iPTH）水平分为两组（ iPTH 300~500ng/L组和iPTH﹥500 ng/L组），各组再随机分成对照组（每晚睡前口服骨化三醇0.5μg）与观察组（夜间睡前口服骨化三醇2μg/次，2次/周）。观察治疗前后的血iPTH、钙及磷水平。结果治疗12周后，iPTH 300~500ng/L组中，观察组和对照组iPTH、矫正钙、磷及钙磷乘积比较，差异均无统计学意义（ P﹥0.05）。治疗12周后，两组矫正钙、钙磷乘积均上升，iPTH均下降，差异有统计学意义（ P﹤0.05）。iPTH﹥500ng/L组中，观察组和对照组iPTH、矫正钙、磷及钙磷乘积比较，差异均无统计学意义（ P﹥0.05）。治疗12周后，观察组矫正钙、钙磷乘积均上升，iPTH下降，差异有统计学意义（ P﹤0.05）。而对照组矫正钙、磷、钙磷乘积以及iPTH与治疗前比较，差异无统计学意义（ P﹥0.05）。结论对于继发中度继发性甲状旁腺功能亢进症的维持性血透患者，骨化三醇冲击治疗优于常规治疗。
목적：비교골화삼순상규구복여충격요법치료유지혈액투석계발갑상방선공능항진（간칭계발성갑방항）적림상료효。방법선취2011년2월-2013년4월본원수치적100례계발갑방항적유지성혈액투석환자，장기안조전단갑상방선소（ iPTH）수평분위량조（ iPTH 300~500ng/L조화iPTH﹥500 ng/L조），각조재수궤분성대조조（매만수전구복골화삼순0.5μg）여관찰조（야간수전구복골화삼순2μg/차，2차/주）。관찰치료전후적혈iPTH、개급린수평。결과치료12주후，iPTH 300~500ng/L조중，관찰조화대조조iPTH、교정개、린급개린승적비교，차이균무통계학의의（ P﹥0.05）。치료12주후，량조교정개、개린승적균상승，iPTH균하강，차이유통계학의의（ P﹤0.05）。iPTH﹥500ng/L조중，관찰조화대조조iPTH、교정개、린급개린승적비교，차이균무통계학의의（ P﹥0.05）。치료12주후，관찰조교정개、개린승적균상승，iPTH하강，차이유통계학의의（ P﹤0.05）。이대조조교정개、린、개린승적이급iPTH여치료전비교，차이무통계학의의（ P﹥0.05）。결론대우계발중도계발성갑상방선공능항진증적유지성혈투환자，골화삼순충격치료우우상규치료。
Objective To compare the efficacy of calcitriol routine and pulse therapy in the treatment of hemodialysis patients with secondary hyperparathyroidism. Methods 100 hemodialysis patients with secondary hyperparathyroidism in our hospital from February 2011 to April 2013,were devided into group iPTH in 300~500ng/L(n=55)and group iPTH﹥500 ng/L(n=45),each group was randomly devided into control group(oral calcitriol 0. 5μg,once a day)and observation group( oral calcitriol 2μg,twice a week). The levels of serum iPTH,calcium and phosphorus before and after treatment were observed. Results After 12 weeks of treatment,iPTH in 300 ~500ng/L group,iPTH,calcium,phosphorus and calcium phosphorus product of observation group and the control group were not significantly different(P﹥0. 05). After 12 weeks of treatment,those two groups of calcium,calcium phosphorus product were increased,iPTH was decreased,the difference were statistically significant(P﹤0. 05). iPTH﹥500ng/L group,iPTH,calcium,phosphorus and calcium phosphorus product of observation group and control group were not significantly different( P﹥0. 05). After 12 weeks of treatment,calcium,calcium phosphorus product of observation group were increased,iPTH decreased,the difference were statistically significant( P ﹤0. 05). While serum calcium,phosphorus,calcium phosphorus product and iPTH of observation group compared with before treatment were not significantly different(P﹥0. 05). Conclusion Calcirtiol pulse therapy in hemodialysis patients with mod-erate secondary hyperparathyroidism was more valuable than routine therapy.