CAJ | 학술논문

目的：观察和分析大剂量骨化三醇冲击疗法治疗终末期肾病（ESRD）并发继发性甲状旁腺功能亢进（SHPT）的临床疗效。方法选取60例ESRD合并中度或重度SHPT患者作为研究对象，将其随机分为观察组和对照组，每组30例。观察组患者给予大剂量骨化三醇冲击治疗，对照组患者给予常规剂量的骨化三醇治疗。对2组患者治疗前、后的血钙、血磷、甲状旁腺素（PTH）、血红蛋白（Hb）和血细胞比容（HCT）水平进行检测，并对患者的皮肤瘙痒改善情况进行评价。结果2组患者治疗后的血清PTH水平和血磷水平均较治疗前显著下降（P＜0．05），而且观察组患者治疗后的血清PTH水平和血磷水平均显著低于对照组（P＜0．05），2组患者治疗后的血钙水平较治疗前显著升高（P＜0．05），而且观察组患者治疗后的血钙水平显著高于对照组（P＜0．05）；2组患者皮肤瘙痒改善的临床有效率分别为90％和40％，观察组的临床有效率显著高于对照组（P＜0．05），而且观察组中疗效为“显效”的患者比例显著高于对照组（P＜0．05）；2组患者治疗后的Hb和HCT水平均较治疗前显著升高（P＜0．05），而且观察组患者治疗后的Hb和HCT水平均显著高于对照组（P＜0．05）。结论应用大剂量骨化三醇冲击疗法治疗ESRD合并SHPT可快速纠正患者的钙磷代谢失衡状态，显著降低患者的血清PTH水平，并可显著缓解患者的皮肤瘙痒和贫血症状。
목적：관찰화분석대제량골화삼순충격요법치료종말기신병（ESRD）병발계발성갑상방선공능항진（SHPT）적림상료효。방법선취60례ESRD합병중도혹중도SHPT환자작위연구대상，장기수궤분위관찰조화대조조，매조30례。관찰조환자급여대제량골화삼순충격치료，대조조환자급여상규제량적골화삼순치료。대2조환자치료전、후적혈개、혈린、갑상방선소（PTH）、혈홍단백（Hb）화혈세포비용（HCT）수평진행검측，병대환자적피부소양개선정황진행평개。결과2조환자치료후적혈청PTH수평화혈린수평균교치료전현저하강（P＜0．05），이차관찰조환자치료후적혈청PTH수평화혈린수평균현저저우대조조（P＜0．05），2조환자치료후적혈개수평교치료전현저승고（P＜0．05），이차관찰조환자치료후적혈개수평현저고우대조조（P＜0．05）；2조환자피부소양개선적림상유효솔분별위90％화40％，관찰조적림상유효솔현저고우대조조（P＜0．05），이차관찰조중료효위“현효”적환자비례현저고우대조조（P＜0．05）；2조환자치료후적Hb화HCT수평균교치료전현저승고（P＜0．05），이차관찰조환자치료후적Hb화HCT수평균현저고우대조조（P＜0．05）。결론응용대제량골화삼순충격요법치료ESRD합병SHPT가쾌속규정환자적개린대사실형상태，현저강저환자적혈청PTH수평，병가현저완해환자적피부소양화빈혈증상。
Obj ective To observe and analyze the curative effect of large dose shock therapy of calcitriol on the treatment of the patients with end-stage renal disease (ESRD)complicated with secondary hyperparathyroidism (SHPT).Methods 60 patients with ESRD complicated with mod-erate or severe SHPT were selected as the research obj ects and randomly divided into the observation group and the control group,30 cases in each group.The patients in the observation group were treated with large dose shock therapy of calcitriol,while the patients in the control group were treated with routine dose therapy of calcitriol.The serum levels of calcium,phosphorus,parathy-roid hormone (PTH),hemoglobin (Hb)and hematocrit (HCT)of the patients in the two groups before and after the treatment were detected.The improvements of the skin itching of the patients were evaluated.Results The serum PTH level and the serum phosphorus levels of the patients in the two groups after the treatment were significantly lower than those before the treatment (P <0 .05 ),and the serum PTH level and the serum phosphorus levels of the patients in the observation group after the treatment were significantly lower than those in the control group (P<0 .05 ).The serum calcium level of the patients in the two groups after the treatment were significantly higher than that before the treatment (P<0 .0 5 ),and the serum calcium level of the patients in the observation group after the treatment were significantly higher than that in the control group (P<0 .05 ).The clinical efficacy in improving skin itching of the patients in the two groups were 90%and 40%,the clinical efficiency of the observation group was significantly higher than that of the control group (P<0 .05 ).Meanwhile,the proportion of the patients with the curative ef-fect of“significant”in the observation group was significantly higher than that in control group (P<0 .05 ).Hb and HCT levels of the patients in the two groups after the treatment were signif-icantly higher than those before the treatment (P<0 .05 ),and Hb and HCT levels of the patients in the observation group after the treatment were significantly higher than those in the control group (P<0 .05 ).Conclusion Application of large doses shock therapy of calcitriol in the treat-ment of ESRD complicated with SHPT can rectify the imbalance calcium and phosphorus metabolism of the patients rapidly,reduced the serum PTH level of the patients significantly,and relieve significantly the symptoms of skin itching or anemia of the patients.