缪蕙 沈明静 黄东梅

【摘要】 目的：观察与探究西那卡塞联合骨化三醇对腹膜透析患者难治性甲状旁腺功能亢进的疗效及其对骨代谢的影响。方法：选取2016年10月-2018年9月本院收治的76例腹膜透析患者难治性甲状旁腺功能亢进为研究对象，根据随机数字表法分为对照组（骨化三醇组）38例和观察组（西那卡塞联合骨化三醇组）38例。比较两组患者治疗后不同时间的临床总有效率，治疗前后全段甲状旁腺激素（iPTH）、血钙（Ca）、血磷（P）水平及达标率，治疗前后骨代谢指标。结果：观察组治疗后不同时间临床总有效率均高于对照组，治疗后iPTH、Ca、P水平均低于对照组，达标率均高于对照组，骨代谢指标均优于对照组，差异均有统计学意义（P<0.05）。结论：西那卡塞联合骨化三醇对腹膜透析患者难治性甲状旁腺功能亢进的疗效较好，且对骨代谢的影响更为积极，因此在腹膜透析患者难治性甲状旁腺功能亢进中的应用价值较高。

【关键词】 西那卡塞; 骨化三醇; 腹膜透析; 难治性甲状旁腺功能亢进; 临床疗效; 骨代谢

【Abstract】 Objective：To observe and investigate the effect of Cinacalcet combined with Calcitriol in the treatment of patients with refractory hyperparathyroidism and peritoneal dialysis and its influence for the bone metabolism.Method：A total of 76 patients with refractory hyperparathyroidism and peritoneal dialysis from October 2016 to September 2018 were chosen for the study，and they were divided into the control group（Calcitriol）38 cases and the observation group（Cinacalcet combined with Calcitriol）38 cases by the method of random number table.Then the total effective rates at different time after the treatment，levels of iPTH，blood Ca and P，before and after the treatment and standard-reaching rates，bone metabolism indexes before and after the treatment of two groups were compared.Result：The total effective rates of observation group at different time after the treatment were all higher than those of the control group，the levels of iPTH，blood Ca and P after treatment were lower than those of the control group，the standard-reaching rates were higher than those of the control group，the bone metabolism indexes were better than those of the control group，the differences of two groups were all statistically significant（P<0.05）.Conclusion：The effect of Cinacalcet combined with Calcitriol in the treatment of refractory hyperparathyroidism and peritoneal dialysis is better，and its influence for the bone metabolism are more active，so its application value in the patients with refractory hyperparathyroidism and peritoneal dialysis is higher.

【Key words】 Cinacalcet; Calcitriol; Peritoneal dialysis; Refractory hyperparathyroidism; Effect; Bone metabolismFirst-authors address：Longgang Central Hospital of Shenzhen City，Shenzhen 518172，China

doi：10.3969/j.issn.1674-4985.2019.15.002

甲状旁腺功能亢进在终末期肾脏病中并不少见，其是本类患者的常见并发症之一，而其中部分患者为难治性甲状旁腺功能亢进，加大了治疗难度的同時，对患者的生存质量也造成更为突出的危害。临床中关于维持性透析患者难治性甲状旁腺功能亢进的研究显示，本类患者除表现出常见的疾病相关症状体征外，其中骨代谢方面的异常也是亟待改善的方面[1-2]。本研究就西那卡塞联合骨化三醇对腹膜透析患者难治性甲状旁腺功能亢进的疗效及其对骨代谢的影响进行观察与探究。……