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目的探讨低钙透析液联合活性维生素D治疗血透患者继发性甲状腺功能亢进的疗效。方法选取2014年1月至2015年10月肾内科收治的25例肾功能衰竭合并甲状旁腺亢进需行血液透析的患者,应用低钙透析液进行透析,同时依据甲状旁腺亢进的程度予以不同剂量的活性维生素D治疗,观察并记录血清钙、磷水平、钙磷乘积、全段甲状旁腺素(iPTH)以及相关不良反应。结果治疗2个月时与治疗前比较,所有患者血清iPTH值显著降低(P<0.05),血钙、钙磷乘积和血磷有所降低,但差异无统计学意义(P均>0.05)。治疗4个月时与治疗前比较,血钙增高(P<0.05),血磷、钙磷乘积、iPTH值均明显降低(P均<0.01);与治疗2个月时比较,钙磷乘积、iPTH值均明显降低(P<0.05,P<0.01)。治疗期间有1例患者发生胃肠道不良反应,经处理后缓解。结论低钙透析液联合活性维生素D的治疗方案对血液透析患者继发性甲状旁腺功能亢进临床疗效良好,各项指标改善明显,可避免高钙血症进而有可能减少心血管钙化的发生率。
Objective To investigate the efficacy of low calcium dialysate combined with active vitamin D in the treatment of secondary hyperthyroidism in hemodialysis patients. Methods From January 2014 to October 2015, 25 cases of hemodialysis patients with renal failure and hyperparathyroidism who were admitted to Department of Nephrology should be treated with low calcium dialysate and dialyzed according to the degree of hyperparathyroidism Dose of vitamin D treatment, observe and record the serum calcium and phosphorus levels, calcium and phosphorus products, the whole parathyroid hormone (iPTH) and related adverse reactions. Results Compared with pretreatment, all patients had significantly lower serum iPTH (P <0.05), lower serum calcium, calcium and phosphorus, and lower serum phosphorus, but the difference was not statistically significant (all P> 0.05). After 4 months of treatment, the serum calcium was increased (P <0.05), and the contents of P, P and iPTH were significantly lower than those before treatment (all P <0.01) iPTH values were significantly lower (P <0.05, P <0.01). During the treatment period, one patient developed gastrointestinal adverse reactions and was relieved after treatment. Conclusion The treatment of low calcium dialysate combined with active vitamin D has a good clinical effect on secondary hyperparathyroidism in hemodialysis patients with obvious improvement of various indexes to avoid the possibility of hypercalcemia and thus reduce the incidence of cardiovascular calcification .