CAJ | 학술논문

【目的】评价持续性非卧床腹膜透析（CAPD）合并重度继发性甲状旁腺功能亢进症（SHPT）患者行阿法骨化醇胶囊（阿法迪三）冲击联合血液灌流（HP）治疗的疗效与安全性。【方法】收集本院 CAPD合并重度 SHPT患者37例。随机分为阿法迪三冲击联合 HP治疗组（A组，19例）和阿法迪三冲击治疗组（B组，18例）。两组药物起始剂量均为每次2～4μg，2次/周。A组同时血灌治疗，1次/周，共治疗3周。随访6月。比较两组治疗前后甲状旁腺激素（iPTH）值，临床症状及心脏瓣膜钙化情况。【结果】①治疗后，联合治疗组iPTH达标率、症状缓解率明显高于单独冲击组，且两组相比较差异有显著性（P＜0．05）。②随访6个月， A组患者心脏瓣膜钙化率低于B组（73．6％ vs 83．3％，P＜0．05）。iPTH 达标率 A组高于 B组（94．7％ vs 77．8％，P＜0．05）。③A组治疗耐受性良好，无一例严重不良反应。B组中3例因高钙高磷血症中断阿法迪三治疗。【结论】合并重度 SHPT的CAPD患者，阿法迪三冲击联合 HP治疗较之单纯阿法迪三冲击具有更好的疗效及耐受性。
【목적】평개지속성비와상복막투석（CAPD）합병중도계발성갑상방선공능항진증（SHPT）환자행아법골화순효낭（아법적삼）충격연합혈액관류（HP）치료적료효여안전성。【방법】수집본원 CAPD합병중도 SHPT환자37례。수궤분위아법적삼충격연합 HP치료조（A조，19례）화아법적삼충격치료조（B조，18례）。량조약물기시제량균위매차2～4μg，2차/주。A조동시혈관치료，1차/주，공치료3주。수방6월。비교량조치료전후갑상방선격소（iPTH）치，림상증상급심장판막개화정황。【결과】①치료후，연합치료조iPTH체표솔、증상완해솔명현고우단독충격조，차량조상비교차이유현저성（P＜0．05）。②수방6개월， A조환자심장판막개화솔저우B조（73．6％ vs 83．3％，P＜0．05）。iPTH 체표솔 A조고우 B조（94．7％ vs 77．8％，P＜0．05）。③A조치료내수성량호，무일례엄중불량반응。B조중3례인고개고린혈증중단아법적삼치료。【결론】합병중도 SHPT적CAPD환자，아법적삼충격연합 HP치료교지단순아법적삼충격구유경호적료효급내수성。
[Objective]To evaluate the efficacy and safety of alfacalcidol[1a-(OH)-D3 ]capsule pulse ther-apy combined with hemoperfusion(HP)for the treatment of continuous ambulatory peritoneal dialysis(CAPD) patients with severe secondary hyperparathyroidism(SHPT).[Methods]Totally 37 CAPD patients with severe SHPT were collected and randomly divided into alfacalcidol pulse therapy combined with HP treatment group (group A,n=19)and alfacalcidol pulse therapy group(group B,n=18).The drug initial dose of two groups was 2~4μg twice a week.Group A simultaneously received HP treatment once a week for 3 weeks.All pa-tients were followed up for 6 months.Immunoreactive parathyroid hormone(iPTH)level,clinical symptoms and cardiac valve calcification before and after treatment were compared.[Results]After treatment,the stand-ard reaching rate of iPTH and symptomatic relief rate in combination group were obviously higher than those in single pulse therapy group,and there was significant difference(P<0.05).After 6 month of follow up,car-diac valve calcification rate in group A was lower than that in group B(73.6% vs.83.3%,P<0.05),while the standard reaching rate of iPTH in group A was higher than that in group B(94.7% vs.77.8%,P <0.05).In group A,the tolerance was good and none had severe side reaction.In group B,3 patients discon-tinued alfacalcidol therapy due to hypercalcemia and hyperphosphatemia.[Conclusion]Alfacalcidol pulse ther-apy combined with HP for the treatment of CAPD patients with severe SHPT has better efficacy and tolerance than single alfacalcidol pulse therapy.