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尿毒症患者不同PTH浓度对阿法D3冲击疗效的影响

ISSN号：2095-5227
期刊名称：《解放军医学院学报》
时间：0
分类：R692.5[医药卫生—泌尿科学;医药卫生—临床医学;医药卫生—外科学]
作者机构：[1]解放军总医院肾科解放军肾病中心暨重点实验室,北京100853
相关基金：国家自然科学基金创新研究群体科学基金资助项目（30121005）

关键词：尿毒症, 甲状旁腺素, 阿法D3, 甲状旁腺功能亢进症, 继发性, uremia, parathyroid hormone, α-D3 , hyperparathyroidism, secondary

中文摘要：

目的：观察尿毒症患者不同甲状旁素（PTH）浓度对阿法D，口服冲击治疗效果的影响。方法：选择我院4JD例血液透析患者分为冲击组（A组）、常规组（B组），依据iPTH浓度每组再分为2亚组（A1和B1组200pg／ml〈iPTH〈500Pg／ml，A2和B2组iPTH≥500pg／m1），分别给予阿法D3口服2pg每周2—3和0．25μg1／d，疗程8周，终点指标iPTH〈200pg／ml。检测治疗前、治疗后4周、8周的iPTH、SC0、SP、AKP及肝肾功能。结果：治疗4周，A1组iPTH下降[（201．32±129．87）vs（332．12±131．29），P〈0．05]，8周iPTH明显下降[（152．78±101．21）vs（332．12±131．29），P〈0．01]；A2组iPTH下降[（489．45±119．68）抛（713．34±137．19），P〈0．05]。A1组iPTH平均下降幅度（60．24±7．93）％，显著大于A2组（31．37±8．63）％。治疗终点达标率A1组明显高于其它组（P〈0．01）。碱性磷酸酶（AKP）A1组和A2组治疗后均较治疗前明显下降。结论：阿法D3口服冲击疗法对于血透患者中度继发性甲旁亢患者疗效更显著，起效更快。

英文摘要：

Objective：To observe the efficacy of different concentration of iPTH on oral pulse α-D3 therapy in uremia patients. Methods： Forty maintance hemodialysis patients were randomly divided into two groups. According to iPTH level （pg/ml）, each group was divided into two subgroups, A1 and Blgroup （200 〈 iPTH 〈 500pg/ml） ,A2 and B2 group（iPTH≥500pg/ml） to receive ct-D3either pulse（ A1 group 2μg twice or A2 group 2μg thrice weekly）or daily（0.25μg every day）oral alfacalcidol in a 8-weeks course. The therapeutic end-point was iPTH 〈 200pg/ml. The changes of iPTH, SCa, SP, AKP and the functions of liver and kidney were observed before and after treatment of the 4th, 8th weeks. Results： In Al group, iPTH de- creased significantly [ （201.32 ± 129.87） vs （ 332.12 ± 131. 291 ）, P 〈 0.05 ] After 4 weeks treatment and more significantly after 8 weeks[ （152.78 ±101.21） vs （332.12 ±131.29 ）, P〈0.01] ;In A2 group, iPTH decreased significantly[ （489.45 ± 119.68） vs （713.34 ± 137.19）, P 〈 0.05 ] after 8 weeks treatment. Mean decrease iPTH in A1 group （ 60.24 ± 7.93 ） % was significantly higher then that in A2 group（ 31.37 ± 8.63）%. The percentage of patients reaching end-point in A1 group was significantly higher than other groups （ P 〈 0. 01 ）. AKP levels decreased significantly in both A1 and A2 after treatment. Conclusion：The efficacy of oral pulse therapy was superior to those of maintance hemodialysis in moderate secondary hyperparathyroidism patients.

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