国际移植与血液净化杂志
國際移植與血液淨化雜誌
국제이식여혈액정화잡지
INTERNATIONAL JOURNAL OF TRANSPLANTATION AND HEMOPURIFICATION
2015年
2期
29-32
,共4页
继发性甲状旁腺机能亢进症%低钙透析%骨化三醇冲击治疗%碳酸钙
繼髮性甲狀徬腺機能亢進癥%低鈣透析%骨化三醇遲擊治療%碳痠鈣
계발성갑상방선궤능항진증%저개투석%골화삼순충격치료%탄산개
High dose Calcitriol therapy%Calcium carbonate%Low calcium dialysis%Secondary hyperparathyroidism
目的 观察骨化三醇冲击治疗同时联合碳酸钙及低钙透析对维持性血液透析继发性甲状旁腺机能亢进症患者的治疗效果,以及对高钙、高磷血症的预防作用.方法 对26例于2013年3至11月在我院行维持性血液透析治疗的继发性甲状旁腺机能亢进症患者采用骨化三醇冲击治疗,餐中咀嚼口服碳酸钙降磷,透析时采用低钙透析液.结果 经过3个月的治疗,2例患者因不能耐受碳酸钙的胃肠道反应,服药1周后停药.1例因PTH持续升高明显,复查B超示甲状旁腺腺瘤形成,后外科行手术切除治疗.2例患者因血磷升高明显(＞ 2.0 mmol/L),暂停骨化三醇冲击治疗.3例患者血钙升高超出目标值(＞ 2.5 mmol/L).其余18例患者均得到了满意的治疗效果.24例研究对象PTH水平明显下降(P＜0.05),ALP水平水平明显下降(P＜0.05),血钙、血磷水平轻度升高,但与治疗前比较差异无统计学意义(P＞0.05).血钙磷乘积水平轻度升高,与治疗前比较差异无统计学意义(P＞0.05).结论 对于维持性血液透析继发甲状旁腺机能亢进症的患者,采用骨化三醇冲击联合口服碳酸钙及低钙透析有明显的治疗作用.
目的 觀察骨化三醇遲擊治療同時聯閤碳痠鈣及低鈣透析對維持性血液透析繼髮性甲狀徬腺機能亢進癥患者的治療效果,以及對高鈣、高燐血癥的預防作用.方法 對26例于2013年3至11月在我院行維持性血液透析治療的繼髮性甲狀徬腺機能亢進癥患者採用骨化三醇遲擊治療,餐中咀嚼口服碳痠鈣降燐,透析時採用低鈣透析液.結果 經過3箇月的治療,2例患者因不能耐受碳痠鈣的胃腸道反應,服藥1週後停藥.1例因PTH持續升高明顯,複查B超示甲狀徬腺腺瘤形成,後外科行手術切除治療.2例患者因血燐升高明顯(＞ 2.0 mmol/L),暫停骨化三醇遲擊治療.3例患者血鈣升高超齣目標值(＞ 2.5 mmol/L).其餘18例患者均得到瞭滿意的治療效果.24例研究對象PTH水平明顯下降(P＜0.05),ALP水平水平明顯下降(P＜0.05),血鈣、血燐水平輕度升高,但與治療前比較差異無統計學意義(P＞0.05).血鈣燐乘積水平輕度升高,與治療前比較差異無統計學意義(P＞0.05).結論 對于維持性血液透析繼髮甲狀徬腺機能亢進癥的患者,採用骨化三醇遲擊聯閤口服碳痠鈣及低鈣透析有明顯的治療作用.
목적 관찰골화삼순충격치료동시연합탄산개급저개투석대유지성혈액투석계발성갑상방선궤능항진증환자적치료효과,이급대고개、고린혈증적예방작용.방법 대26례우2013년3지11월재아원행유지성혈액투석치료적계발성갑상방선궤능항진증환자채용골화삼순충격치료,찬중저작구복탄산개강린,투석시채용저개투석액.결과 경과3개월적치료,2례환자인불능내수탄산개적위장도반응,복약1주후정약.1례인PTH지속승고명현,복사B초시갑상방선선류형성,후외과행수술절제치료.2례환자인혈린승고명현(＞ 2.0 mmol/L),잠정골화삼순충격치료.3례환자혈개승고초출목표치(＞ 2.5 mmol/L).기여18례환자균득도료만의적치료효과.24례연구대상PTH수평명현하강(P＜0.05),ALP수평수평명현하강(P＜0.05),혈개、혈린수평경도승고,단여치료전비교차이무통계학의의(P＞0.05).혈개린승적수평경도승고,여치료전비교차이무통계학의의(P＞0.05).결론 대우유지성혈액투석계발갑상방선궤능항진증적환자,채용골화삼순충격연합구복탄산개급저개투석유명현적치료작용.
Objective To assess the efficacy of hemodialysis patients with secondary hyperparathyroidism treated by high dose calcitriol together wtith calcium carbonate and the low calcium dialysis at the same time,and to assess the preventive effect of hypercalcemia and hyperphosphatemia.Methods During March 2013 to November 2013,29 maintenance hemodialysis patients with secondary hyperparathyroidism were included in the study.All patients used high dose calcitriol therapy.All the patients orally took calcium carbonate and used low calcium dialysate.Results After 3 months of treatment,two cases with gastrointestinal reaction of calcium carbonate were excluded from our study in the first week.One case whose PTH continued to rise (type-B ultrasonic:parathyroid adenoma formation,two gland adenomas ＞ 0.5 cm2) receipted parathyroid gland resection surgery,two cases whose blood phosphorus increased obviously were terminated large dose calcitriol therapy.Three patients blood calcium increased beyond the target(＞ 2.5 mmol/L).The other 18 patients got satisfactory therapeutic effect.The PTH levels in 24 patients decreased obviously(P ＜ 0.05),ALP level declined obviously (P ＜ 0.05),blood calcium elevated moderately,but no statistical significance was found when compared with baseline (P ＞ 0.05).Blood calcium-phosphorus product level elevated moderately but no statistical significance was found when compared with before treatment (P ＞ 0.05).Conclusion High dose calcitriol therapy combined oral calcium carbonate and the low calcium dialysis has obvious therapeutic effect in maintenance hemodialysis patients with secondary hyperparathyroidism.
