论文部分内容阅读
目的 比较1,25(OH)_2D_3(钙三醇)间断冲击与持续小剂量口服两种治疗方法对继发性甲旁亢(secondary Hyper-parathyroidism,SHP)患者的疗效。方法 26例血清甲状旁腺激素全段(Intac parathyroid hormone,iPTH)>20pmol/L的血透患者,随机分为钙二醇口服冲击治疗组(组A)及小剂量治疗组(组B),以iPTH≤10pmol/L为治疗终点,疗程16周。每四周测血清钙(SCa)、磷(SP)、碱性磷酸酶(AKP)及iPTH,疗程结束(或达治疗终点)后测血清骨钙素(BoneGLA protein,BGP)、Ⅰ型前胶原羧基前肽(Carboxy-terminal propeptide of type Ⅰ procollagen,PICP)及Ⅰ型胶原羧基交联调聚肽(Carboxy-teminal cross-linked telopeptide of type,ICTP)。结果 12周及16周后,组A达到治疗终点的百分率显著高于组B(71％ vs 27％),未达到治疗终点的患者,其治疗前的甲状旁腺体积较达到治疗终点的患者显著增大。与治疗前相比,组A第4、8及12周后,iPTH显著降低;8及12周后AKP显著降低,SCa显著增高;12周后,BGP及ICTP显著降低。组B治疗前后上述指标均无明显变化。结论 钙三醇间断口服冲击疗法对血透患者SHP的疗效优于持续小剂量疗法。
Objective To compare the curative effects of 1,25 (OH) _2D_3 (calcitriol) intermittent shock and continuous low-dose oral administration on patients with secondary hyperparathyroidism (SHP). Methods Twenty-six patients with hemodialysis who had intact serum parathyroid hormone (iPTH)> 20 pmol / L were randomly divided into two groups: oral administration of calcium glycol (group A) and low-dose treatment group (group B) To iPTH ≤ 10pmol / L for the treatment of end of treatment for 16 weeks. Serum calcium (SCa), phosphorus (SP), alkaline phosphatase (AKP) and iPTH were measured every four weeks. Serum levels of osteocalcin (BGP), type Ⅰ procollagen carboxyl Carboxy-terminal propeptide of type I procollagen (PICP) and type I collagen carboxylacyl-linked telopeptide of type (ICTP). Results After 12 weeks and 16 weeks, the percentage of group A reaching the end of treatment was significantly higher than that of group B (71% vs 27%). Patients who did not reach the end of treatment had significantly higher volumes of pre-treatment parathyroid compared with patients who reached the end of treatment Increase. After 4, 8 and 12 weeks of group A, iPTH was significantly lower in group A than in the control group; AKP was significantly decreased and SCa was significantly increased at weeks 8 and 12; BGP and ICTP were significantly reduced 12 weeks later. There was no significant change in the above indexes before and after treatment in group B. Conclusion The intermittent oral shock therapy with calcitriol is superior to continuous low-dose therapy in SHP of hemodialysis patients.