中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2015年
8期
1335-1339
,共5页
甲状旁腺功能亢进症,继发性%骨化三醇%肾透析%全段甲状旁腺素
甲狀徬腺功能亢進癥,繼髮性%骨化三醇%腎透析%全段甲狀徬腺素
갑상방선공능항진증,계발성%골화삼순%신투석%전단갑상방선소
Hyperparathyroidism,secondary%Calcitriol%Renal dialysis%Intact parathyroid hormone
目的：探讨不同剂量骨化三醇治疗血液透析引起的继发性甲状旁腺功能亢进（SHPT）的疗效观察。方法选择我院80例慢性肾衰竭患者，分为非透析组与透析组，其中透析组根据治疗剂量不同分为常规组与冲击治疗组，冲击治疗组再根据全段甲状旁腺素（iPTH）浓度分为亚组，每组分别给予不同剂量骨化三醇口服18周，分别测定治疗前及治疗后第3周、6周、9周、12周、18周时的碱性磷酸酶（AKP）、iPTH、Ca2+、P3+、spKt/V、Hb、Scr等指标。iPTH＜300 pg/ml为治疗达标。结果治疗9周时冲击治疗组B1组iPTH开始下降[（282.62±93.68）pg/ml vs.（509.54±99.08） pg/ml]，差异具有统计学意义（P＜0.05）；治疗12周和18周时与第9周时相比变化不大，差异不具有统计学意义（P＞0.05）。B2组在第9周时iPTH开始下降[（553.27±96.82）pg/ml vs.（896.51±104.34） pg/ml，P＜0.01]；至12周时iPTH复升[（595.72±121.61）pg/ml vs.（896.51±104.34）pg/ml]，差异仍具有统计学意义（P＜0.05）。而B3组在第12周时开始下降[（868.53±205.35）pg/ml vs.（2024.31±162.29）pg/ml]，差异具有统计学意义（P＜0.01）；至18周时iPTH持续下降。冲击治疗组与常规治疗组相比，iPTH下降明显，达标率高，钙磷乘积相对升高，结合患者的临床症状改善，差异具有统计学意义。结论骨化三醇冲击疗法对SHPT有显著疗效，安全性高，冲击疗法较常规治疗效果更为显著。
目的：探討不同劑量骨化三醇治療血液透析引起的繼髮性甲狀徬腺功能亢進（SHPT）的療效觀察。方法選擇我院80例慢性腎衰竭患者，分為非透析組與透析組，其中透析組根據治療劑量不同分為常規組與遲擊治療組，遲擊治療組再根據全段甲狀徬腺素（iPTH）濃度分為亞組，每組分彆給予不同劑量骨化三醇口服18週，分彆測定治療前及治療後第3週、6週、9週、12週、18週時的堿性燐痠酶（AKP）、iPTH、Ca2+、P3+、spKt/V、Hb、Scr等指標。iPTH＜300 pg/ml為治療達標。結果治療9週時遲擊治療組B1組iPTH開始下降[（282.62±93.68）pg/ml vs.（509.54±99.08） pg/ml]，差異具有統計學意義（P＜0.05）；治療12週和18週時與第9週時相比變化不大，差異不具有統計學意義（P＞0.05）。B2組在第9週時iPTH開始下降[（553.27±96.82）pg/ml vs.（896.51±104.34） pg/ml，P＜0.01]；至12週時iPTH複升[（595.72±121.61）pg/ml vs.（896.51±104.34）pg/ml]，差異仍具有統計學意義（P＜0.05）。而B3組在第12週時開始下降[（868.53±205.35）pg/ml vs.（2024.31±162.29）pg/ml]，差異具有統計學意義（P＜0.01）；至18週時iPTH持續下降。遲擊治療組與常規治療組相比，iPTH下降明顯，達標率高，鈣燐乘積相對升高，結閤患者的臨床癥狀改善，差異具有統計學意義。結論骨化三醇遲擊療法對SHPT有顯著療效，安全性高，遲擊療法較常規治療效果更為顯著。
목적：탐토불동제량골화삼순치료혈액투석인기적계발성갑상방선공능항진（SHPT）적료효관찰。방법선택아원80례만성신쇠갈환자，분위비투석조여투석조，기중투석조근거치료제량불동분위상규조여충격치료조，충격치료조재근거전단갑상방선소（iPTH）농도분위아조，매조분별급여불동제량골화삼순구복18주，분별측정치료전급치료후제3주、6주、9주、12주、18주시적감성린산매（AKP）、iPTH、Ca2+、P3+、spKt/V、Hb、Scr등지표。iPTH＜300 pg/ml위치료체표。결과치료9주시충격치료조B1조iPTH개시하강[（282.62±93.68）pg/ml vs.（509.54±99.08） pg/ml]，차이구유통계학의의（P＜0.05）；치료12주화18주시여제9주시상비변화불대，차이불구유통계학의의（P＞0.05）。B2조재제9주시iPTH개시하강[（553.27±96.82）pg/ml vs.（896.51±104.34） pg/ml，P＜0.01]；지12주시iPTH복승[（595.72±121.61）pg/ml vs.（896.51±104.34）pg/ml]，차이잉구유통계학의의（P＜0.05）。이B3조재제12주시개시하강[（868.53±205.35）pg/ml vs.（2024.31±162.29）pg/ml]，차이구유통계학의의（P＜0.01）；지18주시iPTH지속하강。충격치료조여상규치료조상비，iPTH하강명현，체표솔고，개린승적상대승고，결합환자적림상증상개선，차이구유통계학의의。결론골화삼순충격요법대SHPT유현저료효，안전성고，충격요법교상규치료효과경위현저。
Objective To evaluate the efficacy of different doses of calcitriol on continuous hemodialysis patients with secondary hyperparathyroidism (SHPT). Methods Eighty chronic kidney disease (CKD) cases from our hospital were selected. And the cases were randomly sorted in none-dialysis group and dialysis group. Common dose group and large dose group were distinguished from dialysis group. On the basis of serum intact parathyroid hormone, the cases were randomized different doses of calcitriol for 18 weeks, and alkaline phosphatase (AKP), iPTH, Ca2+, P3+, spKt/V, Hb, Scr were measured at baseline and every 3 weeks. iPTH<300 pg/ml was the standard. Results Serum iPTH of Group B1 began to decrease at 9th week, (282.62±93.68)pg/ml vs. (509.54±99.08)pg/ml, and with statistical differences (P<0.05). There were no significant difference between 12th week with 18th week and 9th week (P>0.05). Group B2 began to decrease at 9th week, (553.27±96.82)pg/ml vs. (896.51±104.34)pg/ml (P<0.01), but increased at 12th week with statistical differences, (595.72±121.61) pg/ml vs. (896.51±104.34)pg/ml (P<0.05). Group B3 began to decrease at 12th week with statistical differences, (868.53±205.35)pg/ml vs. (2 024.31±162.29)pg/ml (P<0.01), in addition, serum iPTH decreased continuously. Compared to group common dose, the group with large dose obviously decreased serum iPTH, higher attainment rate, serum calcium-phosphorus (Ca×P) product increased clearly, and patients’ clinical symptom improved much more. Conclusion Large dose calcitriol is significantly efficacious and highly safety in treating SHPT. Moreover, in contrast with group with common dose, large dose calcitriol is effective in treatment.
