洪滔 杨枫

[摘要] 目的 观察继发性甲状旁腺功能亢进症患者给予不同剂量骨化三醇治疗的远期疗效。 方法 选择2018年3月至2019年3月就诊于我院的92例继发性甲状旁腺功能亢进症患者为研究对象，采用随机数字表法分为对照组和观察组，每组各46例，其中对照组给予常规剂量骨化三醇治疗，0.25 μg/次，1次/d，观察组给予骨化三醇冲击治疗，血透日给药2 μg/次，3次/周，两组患者均治疗3个月后进行为期1年的随访观察，对比两组患者治疗前后症状改善情况、血钙、血磷、钙磷乘积、甲状旁腺激素（PTH）水平。 结果 观察组患者症状改善率为91.30%，显著高于对照组的71.74%，差异有统计学意义（P<0.05）;两组治疗前、治疗后6个月、12个月血钙、血磷、钙磷乘积水平比较，差异无统计学意义（P>0.05），两组治疗后6个月、12个月血钙、血磷、钙磷乘积水平均较治疗前升高，差异有统计学意义（P<0.05）;观察组治疗后6个月、12个月PTH水平均低于治疗前，且明显低于对照组，差异有统计学意义（P<0.05）。 结论 继发性甲状旁腺功能亢进症患者给予不同剂量骨化三醇均可導致血钙、血磷代谢受到影响，但采用骨化三醇冲击治疗的患者可以有效改善临床症状，纠正PTH水平，疗效值得肯定。

[关键词] 骨化三醇;冲击治疗;继发性甲状旁腺功能亢进症;远期疗效

[中图分类号] R581.1          [文献标识码] B          [文章编号] 1673-9701（2021）08-0057-03

The long-term efficacy of different doses of calcitriol on secondary hyperparathyroidism

HONG Tao   YANG Feng

Department of Nephrology， Fuzhou First Hospital， Fuzhou   350009， China

[Abstract] Objective To observe the long-term efficacy of different doses of calcitriol in patients with secondary hyperparathyroidism. Methods A total of 92 patients with secondary hyperparathyroidism treated in our hospital from March 2018 to March 2019 were selected as the research objects. They were divided into the control group and the observation group by random number table method， with 46 cases in each group. The control group was given a regular dose of calcitriol treatment， 0.25 μg/time， one time/d. The observation group was given calcitriol shock therapy， 2 μg/time on the day of hemodialysis， 3 times/week. After three months of treatment， a one-year follow-up observation was conducted. The improvement of symptoms， blood calcium， blood phosphorus， calcium-phosphorus product and parathyroid hormone（PTH） levels of the two groups before and after treatment were compared. Results The observation group's symptom improvement rate was 91.30%， which was significantly higher than that of 71.74% in the control group. The difference in the data between the two groups was statistically significant（P<0.05）. There was no statistically significant difference in blood phosphorus， calcium， and calcium phosphorus product levels before treatment， at 6 months and 12 months after treatment（P>0.05）. The blood calcium， blood phosphorus， and calcium-phosphorus product levels of the two groups at 6 months and 12 months after treatment were higher than those before treatment， with statistically significant difference（P<0.05）. The PTH levels in the observation group at 6 months and 12 months after treatment were lower than those before treatment，and were lower than those in the control group. The difference was statistically significant （P<0.05）. Conclusion Different doses of calcitriol in patients with secondary hyperparathyroidism can affect the metabolism of blood calcium and phosphorus. However， calcitriol shock therapy can effectively improve the patients clinical symptoms and correct PTH levels， with a positive curative effect.

[Key words] Calcitriol; Shock therapy; Secondary hyperparathyroidism; Long-term efficacy

继发性甲状旁腺功能亢进症是因慢性肾脏疾病、内分泌失调、低血钙等原因引发的代谢性疾病，该病患者以甲状旁腺长期分泌过量甲状旁腺激素（Parathyroid hormone，PTH）为典型征象，可导致其出现骨骼疼痛、皮肤瘙痒、肌萎缩等症状[1]。临床治疗继发性甲状旁腺功能亢进症以药物治疗为首选方法，其目标为提高血钙浓度，并抑制PTH过量分泌[2-3]。骨化三醇是临床常用的补充钙剂，多项报道提示其应用效果良好[4-5]。但应注意的是，若骨化三醇给药剂量不当，会导致患者血钙、血磷水平升高，促进软组织及血管钙化[6-7]。为此，本研究以我院收治的继发性甲状旁腺功能亢进症患者为例，通过给予其不同剂量的骨化三醇，分析最恰当的给药剂量，确保患者治疗安全，现报道如下。……