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Received:February 23, 2024 Published Online:September 20, 2024
Received:February 23, 2024 Published Online:September 20, 2024
中文摘要: 目的 观察对尿毒症血液透析(HD)伴继发性甲状旁腺功能亢进(SHPT)患者,开展西那卡塞+骨化三醇+碳酸镧联合治疗的疗效。方法 选取2020年1月至2022年12月黄山市人民医院收治的尿毒症HD伴SHPT患者80例,按随机数字表法分为对照组(40例,骨化三醇治疗)和研究组(40例,西那卡塞+骨化三醇+碳酸镧联合治疗),比较两组钙磷乘积、全段甲状旁腺激素(iPTH)、甲状旁腺体积、颈动脉内膜中层厚度(IMT),以及不良反应。结果 与治疗前比较,两组治疗1个月、3个月、6个月钙磷乘积、iPTH降低(P<0.05),且与对照组比较,研究组治疗1个月、3个月、6个月钙磷乘积、iPTH更低(P<0.05)。与治疗前比较,两组治疗1个月、3个月、6个月甲状旁腺体积降低(P<0.05),研究组治疗3个月、6个月颈动脉IMT降低(P<0.05),对照组治疗6个月IMT降低(P<0.05),且与对照组比较,研究组治疗3个月、6个月甲状旁腺体积、IMT更低(P<0.05)。研究组不良反应发生率17.50%,与对照组的15.00%比较,差异无统计学意义(χ2=0.092, P=0.762)。结论 对尿毒症HD伴SHPT患者,应用西那卡塞+骨化三醇+碳酸镧联合治疗,可改善钙磷代谢,调节iPTH,减少甲状旁腺体积和颈动脉粥样硬化风险,且不会增加不良反应。
Abstract:Objective To observe the efficacy of combined treatment with cinacalcet, calcitriol, and lanthanum carbonate in uremia patients undergoing hemodialysis (HD) with secondary hyperparathyroidism (SHPT). Methods From January 2020 to December 2022, 80 uremia patients under HD with SHPT treated at Huangshan City People's Hospital were selected. They were randomly divided into the control group (40 cases, treated with calcitriol) and the study group (40 cases, treated with a combination of cinacalcet, calcitriol, and lanthanum carbonate). The calcium-phosphorus product, intact parathyroid hormone (iPTH), parathyroid volume, and carotid intima-media thickness (IMT), as well as adverse reactions, were compared between the two groups. Results Compared with before treatment, both groups showed a decrease in calcium-phosphorus product and iPTH after 1, 3, and 6 months of treatment (P<0.05). Moreover, compared with the control group, the study group had lower calcium-phosphorus product and iPTH after 1, 3, and 6 months of treatment (P<0.05). Compared with before treatment, both groups showed a reduction in parathyroid volume after 1, 3, and 6 months of treatment (P<0.05). The study group also showed a reduction in carotid IMT after 3 and 6 months of treatment (P<0.05), while the control group showed a reduction in IMT after 6 months of treatment (P<0.05). Furthermore, compared with the control group, the study group had lower parathyroid volume and IMT after 3 and 6 months of treatment (P<0.05). The incidence of adverse reactions in the study group was 17.50%, which was not significantly different from the 15.00% in the control group (χ2=0.092, P=0.762). Conclusion For uremia patients under HD accompanied by SHPT, combined treatment of cinacalcet, calcitriol, and lanthanum carbonate can improve calcium and phosphorus metabolism, regulate iPTH, reduce parathyroid volume and the risk of carotid atherosclerosis, without increasing adverse reactions.
keywords: Uremia Hemodialysis Secondary hyperparathyroidism Cinacalcet Calcitriol Lanthanum carbonate
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基金项目:安徽省重点研究与开发计划项目(202104a05020085);皖南医学院校级科研专项(JXYY202263)
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