不同用药方案对血液透析患者继发性甲状旁腺功能亢进症疗效观察

陈燕 张英姿 姚霞娟 吴娱 胡宏

[摘要] 目的 探討不同用药方案对血透患者继发性甲状旁腺功能亢进症（SHPT）治疗的有效性及安全性的影响。 方法 选取本院2019年12月至2020年12月确诊的SHPT患者105例作为研究对象，将其随机分为单一药物组和联合药物组，其中单一药物组又根据使用的药物不同分为司维拉姆组、碳酸镧组和碳酸钙组;联合药物组根据使用的药物不同分为司维拉姆联合西那卡塞组和碳酸镧联合西那卡塞组。经过3个月治疗，监测五组患者血钙、血磷、血甲状旁腺激素（iPTH）的变化及出现的不良反应，综合评估诊疗效果。 结果 碳酸钙能够达到降磷功效，但药物治疗3个月后，患者血钙上升（P>0.05）;服用碳酸镧、司维拉姆组治疗后血钙、血磷、iPTH水平均有下降趋势（P<0.05），其中碳酸镧组和司维拉姆组血钙水平低于碳酸钙组（P>0.05），三组血磷及iPTH水平比较，差异均无统计学意义（P>0.05）。司维拉姆联合西那卡塞组治疗后血钙、血磷、iPTH水平较治疗前明显降低，差异有统计学意义（P<0.05），并出现1例肌痛患者;碳酸镧联合西那卡塞组表现出同样趋势，治疗后血磷、iPTH水平较治疗前降低幅度较大（P<0.05），血钙并未升高，出现2例不良反应患者。 结论 司维拉姆联合西那卡塞及碳酸镧联合西那卡塞可有效降低SHPT患者血磷及iPTH，且没有高钙血症的副作用，碳酸钙是透析初期患者降磷补钙的不错选择，而碳酸镧和司维拉姆的使用可以更好地延缓血管钙化进程。

[关键词] 继发性甲状旁腺功能亢进症;血液透析;司维拉姆;碳酸镧;西那卡塞

[中图分类号] R692.5          [文献标识码] B          [文章编号] 1673-9701（2021）34-0039-05

[Abstract] Objective To explore the effect of different medication regimens on the efficacy and safety of secondary hyperparathyroidism（SHPT） treatment in hemodialysis patients. Methods A total of 105 patients with SHPT diagnosed in our hospital from December 2019 to December 2020 were selected as the study subjects and randomly divided into the single drug group and the combined drug group， in which the single drug group was divided into the sevelamer group， the lanthanum carbonate group and the calcium carbonate group according to different drugs used. The combined drug group was divided into the sevelamer combined with cinacalcet group and the lanthanum carbonate combined with cinacalcet group according to different drugs used. After three months of treatment，the changes in serum calcium， serum phosphorus， serum parathyroid hormone（iPTH），and adverse reactions were monitored in the five groups. The diagnosis and treatment effect was comprehensively evaluated. Results Calcium carbonate could achieve the effect of lowering phosphorus， but after three months of drug treatment，serum calcium increased（P>0.05）. After treatment， the serum calcium， serum phosphorus，and iPTH levels in the lanthanum carbonate and sevelamer group tended to decrease（P<0.05）.The serum calcium level in the lanthanide carbonate group and the sevelamer group was lower than in the calcium carbonate group（P>0.05）. There were no significant difference in serum phosphorus and iPTH levels among the three groups（P>0.05）. After treatment，the serum calcium， serum phosphorus， and iPTH levels in the sevelamer combined with cinacalcet group were significantly lower than those before treatment，and the differences were statistically significant（P<0.05）.And one patient had myalgia. The lanthanum carbonate combined with cinacalcet group showed the same trend. The serum phosphorus and iPTH levels after treatment were significantly lower than those before treatment（P<0.05）. Serum calcium did not increase，and two patients had adverse reactions. Conclusion Sevelamer combined with cinacalcet and lanthanum carbonate combined with cinacalcet can effectively reduce blood phosphate and iPTH in patients with SHPT， without the side effects of hypercalcemia. Calcium carbonate is a good choice for reducing phosphorus and supplementing calcium in patients at the early stage of dialysis， while the use of lanthanum carbonate and sevelamer can better delay the process of vascular calcification.