|
|
|
| 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 |
| ZHANG Wenbo, et al |
| Pearl River Hospital Affiliated to Southern Medical University, Guangdong Guangzhou 510282, China |
|
|
|
|
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.
|
|
|
|
|
|
[1] 张蕊,张念荣,席秋萍,等.维持性血液透析合并难治性继发性甲状旁腺功能亢进患者腹主动脉钙化相关因素分析[J].肾脏病与透析肾移植杂志,2017,26(5):38~43.
[2] Hawley C M,Holt S G.Parathyroid hormone targets in chronic kidney disease and managing severe hyperparathyroidism[J].Nephrology,2017,22 Suppl 2(7):47~50.
[3] 郭燕, 李卫华,陈列.维持性血液透析患者甲状旁腺激素水平及C反应蛋白对心脏结构功能影响的临床分析[J].中国临床医生杂志,2016,44(3):60~63.
[4] 王蔚.活性维生素D及其类似物治疗血液透析患者继发性甲状旁腺功能亢进相关指南推荐[J].肾脏病与透析肾移植杂志,2017,26(4):381~385.
[5] Conigrave A D.The calcium-sensing receptor and the parathyroid:past present future[J].Front Physiol,2016,7:563.
[6] 张鹏,何晓东,陈望,等.厄贝沙坦联合活性维生素D对IgA肾病患者免疫功能及TGF-β1和sTfR表达的影响[J].临床和实验医学杂志,2018,17(5):495~499.
[7] 周露,赵文琪,叶婷,等.西那卡塞联合活性维生素D治疗维持性血液透析继发性甲状旁腺功能亢进症的疗效观察[J].中国中西医结合急救杂志,2017,24(6):650~653.
[8] Tanaka M,Yoshida K,Fukuma S,et al.Effects of secondary hyperparathyroidism treatment on improvement in anemia:results from the MBD-5D study[J].Plos One,2016,11(10):e0164865.
[9] 袁芳,陈星,王畅,等.西那卡塞联合小剂量骨化三醇治疗重度继发性甲状旁腺功能亢进的效果及其对骨代谢的影响[J].中南大学学报(医学版),2017,42(10):47~51.
[10] De K S,Muylle K,Tsoumalis G,et al.Primary hyperparathyroidism associated to thrombocytopenia:an issue to consider[J].Clin Cases Miner Bone Metab,2017,14(1):97~102.
[11] Jeong S, Kim I W, Oh K H, et al. Pharmacogenetic analysis of cinacalcet response in secondary hyperparathyroidism patients[J]. Drug Des Devel Ther, 2016,10(1):2211~2225. |
|
|
|
2019, Vol. 25 
