骨化三醇不同治疗方法对尿毒症维持性血透患者SHPT远期疗效分析

目的探讨骨化三醇常规剂量治疗和冲击治疗对尿毒症维持性血透患者继发性甲状旁腺功能亢进(SHPT)的远期疗效.方法选取38例连续接受血液透析的尿毒症合并SHPT患者,将患者分为冲击治疗组(21例),常规治疗组(17例).常规治疗组给予三醇口服0.25~0.50μg,每晚1次;冲击治疗组根据患者甲状旁腺激素水平给予不同剂量骨化三醇.比较两组患者治疗前后的甲状旁腺激素、血钙、血磷、钙磷乘积水平以及临床症状变化.结果两组患者总有效率之间差异无统计学意义(P0.05);治疗后两组患者甲状旁腺激素水平均明显降低,与治疗前相比差异具有统计学意义(P0.05).结论两种治疗方法远期疗效无明显差异,但常规治疗可降低高血钙和高钙磷乘积的发生率,降低患者心血管事件的发生风险.因此,对尿毒症患者推荐选择骨化三醇常规剂量治疗.

Long-term Therapeutic Effects Analysis of Calcitriol at Different Dosages in the Patients with SHPT Accepted Maintenance Hemodialysis

Objective To explore long-term therapeutic effects of calcitriol at routine and pulse dose on the uremia patients with secondary parathyroid hyperfunction( SHPT) accepted maintenance hemodialysis. Method A total of 38 patients with SHPT accepted hemodialysis uremic were enrolled in this study. According to their medical record number, the patients were divided into pulse treatment group ( 21 cases ) and conventional treatment group(17 cases). The implosive treatment group was treated with 0. 25~0. 50 μg calcitriol,1 time per night. The treatment group was administrated calcitriol at different dosages according to the level of parathyroid hormone. The levels of serum calcium, serum phosphorus and calcium phosphorus product and the clinical symptoms were compared between the two groups before and after treatment. Results There was no significant difference in the total treatment efficiency between two groups(P>0. 05). After treatment,the parathyroid hormone levels of the patients in the two groups decreased significantly ( P<0 . 05 ) . Conclusion There was no obvious difference in the long-term therapeutic effect between the two treatment methods. However, the routine treatment could reduce the incidences of high blood calcium, calcium phosphorus product, and the risk of cardiovascular events in the patients. Therefore,the routine dose treatment of calcitriol is recommended.