肖友文 张帆 周涛 鲍永强 潘红霞

【摘 要】目的：觀察盐酸西那卡塞、骨化三醇冲击治疗联合不同透析方式治疗维持性血液透析（maintenance hemodialysis，MHD）患者继发性甲状旁腺功能亢进（secondary hyperparathyroidism，SHPT）的疗效。方法：将70例患者随机分为A、B两组（各35例），B组每周高通量血液透析2次、高通量血液透析并血液灌流1次，A组每周高通量血液透析3次，两组均同时使用大剂量盐酸西那卡塞、骨化三醇冲击治疗，观察时限12周。治疗前及治疗开始后分别于第4周、第8周、第12周检测两组患者血清钙（calcium，Ca）、磷（phosphorus，P）及全段甲状旁腺激素（Parathyroid Hormone，iPTH）浓度并进行比较，并观察记录患者骨痛、肌无力、皮肤瘙痒等临床症状情况。结果：两组患者组内比较血清Ca、血清P、血清iPTH均较治疗前明显降低，在治疗4周后血清Ca水平开始下降（P<0.01），治疗结束时均较治疗前明显降低（P<0.01）； A、B两组患者治疗到第4周，血磷均有明显下降（P<0.01），而两组血磷在治疗后第8周、第12周则无明显下降，均维持在较高水平；A、B两组患者治疗到第4周，血清iPTH较治疗前明显下降（P<0.01），第8周、第12周iPTH血中浓度均较相对稳定；A、B两组患者组间比较血清Ca、血清P、血清iPTH各时间点，无统计学差异；A、B两组患者骨痛、肌无力、皮肤瘙痒等临床症状均明显改善。结论：大剂量盐酸西那卡塞、骨化三醇冲击联合高通量血液透析、血液灌流能有效抑制MHD患者SHPT， 明显降低血清iPTH及血磷，增强了冲击治疗的安全性和有效性。

【关键词】继发性甲状旁腺功能亢进；血液灌流；西那卡塞；骨化三醇；冲击疗法

Abstract Objective： The observation of the therapeutic affections on hemoperfusion combined with regpara and calcitriol impact therapy on SHPT of maintenance hemodialysis（MHD）patients.Methods： 70 patients were randomly divided into Group A （n=35）and Group B（n=35）. Patients in Group A underwent conventional hemodialysis treatment 2 times and hemodialysis combined with hemoperfusion once a week， while those in group B only underwent conventional hemodialysis treatment 3 times a week. Both Group A and Group B accepted regpara and calcitriol impact therapy at the same time. All objects were treated for 12 weeks. Some indexes such as Serum calcium（Ca）， phosphorus（P）and intact parathyroid hormone（iPTH）were detected and analyzed before and after treatment at 4 weeks， 8 weeks and 12 weeks， and changes of clinic symptoms such as ostealgia， myasthenia and skin itch were observed. Results： The serum Ca in both Group A and Group B began to rise after 4 weeks' treatment（P<0.05）and rose obviously at the end of treatment（P<0.01）. After therapy， Serum P of Group A decreased significantly（P<0.01）， but it had no significant deference in Group B before and After treatment（P>0.05）. After 4 weeks' treatment， serum iPTH of Group A decreased significantly（P<0.01）and it was lower than that of homochronous Group B after 8 weeks' treatment or 12 weeks' treatment（P<0.05 or P<0.01）. Clinic symptoms such as ostealgia， myasthenia and skin itch of both Group A and Group B were obviously improved.Conclusion： Hemoperfusion combined with calcitriol impact therapy could effectively control SHPT， reduce serum iPTH and P and enhance safety and efficacy of calcitriol impact therapy.

Key words： secondary hyperparathyroidism； hemoperfusion； regpara；calcitriol； impact therapy

【中图分类号】R553.6 【文献标识码】A 【文章编号】1672-3783（2017）11-03-0-01

近年来我国CKD发病率呈现出逐年升高的趋势[1]，截止到2014年，CKD患者已经接近10.8%[2]，血液透析作为目前治疗慢性肾功能衰竭的主要手段，在延长患者寿命进程中发挥着重要的作用，但是随着维持性血液透析（MHD）患者生存期的延长，其并发症的防治显得尤为重要，其中继发性甲状旁腺功能亢进（SHPT）由于可以明显影响患者生存质量[3]，成为终末期肾脏病治疗领域的研究热点。因此，我们将高通量血液透析及血液透析联合血液灌流两种不同方式均联合使用大剂量盐酸西那卡塞、骨化三醇冲击治疗对SHPT进行强化治疗的效果进行观察比较，现报告如下。……