活性维生素D联合西那卡塞治疗慢性肾衰竭透析患者继发甲状旁腺功能亢进疗效及对TGF-β1和sTfR水平的影响

doi:10.3969/j.issn.1006-6233.2019.12.007

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摘要目的:观察活性维生素D联合西那卡塞治疗慢性肾衰竭透析患者继发甲状旁腺功能亢进(SHPT)的疗效及对血清转化生长因子-β1(TGF-β1)和血清转铁蛋白受体(sTfR)水平的影响。方法:90例慢性肾衰竭行MHD而致中重度SHPT患者随机分为对照组和观察组,每组45例,对照组予以骨化三醇治疗,观察组予以骨化三醇联合西那卡塞治疗;比较两组临床疗效及治疗前后甲状旁腺大小、血钙、血磷、全段甲状旁腺激素(iPTH)、肾功能指标、TGF-β1、sTfR水平变化,并观察两组不良反应。结果:观察组总有效率为93.33%,对照组总有效率为75.56%,组间比较有统计学差异(P<0.05)。治疗后,观察组甲状旁腺长、宽、厚减小较对照组更显著(P<0.05),血钙增高较对照组更显著(P<0.05),血磷及iPTH降低较对照组更显著(P<0.05);两组治疗前后肾功能指标[血肌酐、尿素氮、尿素清除指数]均无明显变化(P>0.05)。治疗后,两组血清TGF-β1、sTfR均明显降低(P<0.05),且观察组较对照组降低更显著(P<0.05)。两组不良反应发生率比较无统计学差异(P>0.05)。结论:骨化三醇联合西那卡塞治疗慢性肾衰竭MHD患者SHPT疗效显著,能够有效改善高iPTH状态及钙磷失衡,降低TGF-β1、sTfR表达,且不会对残余肾功能造成不良影响,安全性良好。

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关键词 ：慢性肾衰竭, 血液透析, 继发性甲状旁腺功能亢进, 西那卡塞, 活性维生素D

Abstract：Objective: To observe the efficacy of active vitamin D combined with cinacalcet in the treatment of secondary hyperparathyroidism (SHPT) in dialysis patients with chronic renal failure and its effects on levels of serum transforming growth factor-β1 (TGF-β1) and serum transferrin receptor (sTfR). Methods: 90 patients with chronic renal failure who underwent MHD causing moderate-to-severe SHPT were randomly divided into control group and observation group, with 45 cases in each group. Control group was treated with calcitriol, and observation group was given calcitriol combined with cinacalcet. The clinical efficacy and changes of parathyroid size, blood calcium, blood phosphorus, intact parathyroid hormone (iPTH), renal function indexes, TGF-β1 and sTfR before and after treatment were compared between the two groups, and adverse reactions were observed in the two groups. Results: The total effective rate was 93.33% in observation group and 75.56% in control group (P<0.05). After treatment, the decreases of length, width and thickness of parathyroid glands in observation group were more significant than those in control group (P<0.05), and the increase of blood calcium was more significant than that in control group (P<0.05), and the decreases of blood phosphorus and iPTH were more significant than those in control group (P<0.05). There were no significant changes in renal function indexes [serum creatinine, urea nitrogen, urea clearance index] before and after treatment between the two groups (P>0.05). After treatment, the serum levels of TGF-β1 and sTfR were significantly decreased in the two groups (P<0.05), and the decreases in observation group were more significant than those in control group (P<0.05). There was no significant difference in the incidence rate of adverse reactions between the two groups (P>0.05). Conclusion: Calcitriol combined with cinacalcet has significant efficacy in the treatment of SHPT in MHD patients with chronic renal failure, and it can effectively improve the high iPTH status and calcium and phosphorus imbalance, reduce the expressions of TGF-β1 and sTfR, and will not adversely affect residual renal function, with good safety.

Key words： Chronic renal failure Hemodialysis Secondary hyperparathyroidism Cinacalcet Active vitamin D

基金资助:广东省科技计划项目,(编号:2016ZC034018)

通讯作者: 牛红心

引用本文:

张文博, 霍延红, 焦娟, 张鑫, 牛红心. 活性维生素D联合西那卡塞治疗慢性肾衰竭透析患者继发甲状旁腺功能亢进疗效及对TGF-β1和sTfR水平的影响[J]. 河北医学, 2019, 25(12): 1961-1965.
ZHANG Wenbo, et al. Efficacy of Active Vitamin D combined with Cinacalcet on Secondary Hyperparathyroidism in Dialysis Patients with Chronic Renal Failure and its Effects on Levels of TGF-β1 and sTfR. HeBei Med, 2019, 25(12): 1961-1965.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2019.12.007 或 http://www.hbyxzzs.cn/CN/Y2019/V25/I12/1961

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