摘要
目的探讨老年维持性血液透析(maintenance hemodialysis,MHD)患者并发严重继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)使用药物联合治疗的临床疗效,为临床治疗探索更好的治疗手段。方法收集2023年1-8月血液透析室的老年MHD并发严重SHPT患者90例,根据试验前血清钙、磷检测结果及给药方案将患者分成A组、B组、C组(各组n=30例),A组患者使用拟钙剂、非含钙磷结合剂及维生素D类似物三者联合治疗,B组患者使用拟钙剂、非含钙磷结合剂两者联合治疗,C组患者使用维生素D类似物、非含钙磷结合剂两者联合治疗,三组患者均连续治疗3个月。采集患者年龄、性别等一般信息,对三组患者的疗效进行比较,同时比较治疗前后的血清钙(serum calcium,Ca)、血清磷(serum phosphorus,P)、血清镁(serum magnesium,Mg)、血全段甲状旁腺激素(intact parathyroid hormone,iPTH)、血清白蛋白(serum albumin,Alb)、血碱性磷酸酶(alkaline phosphatase,AKP)及25羟基维生素D[25-hydroxy vitamin D,25-(OH)D]水平,治疗前后甲状旁腺体积、骨密度T值、腹主动脉钙化评分(abdominal aortic calcification scores,AACs)变化情况以及对三组患者的药物不良反应进行分析。结果治疗3个月后A、B、C三组患者iPTH值较治疗前有所下降,总有效率为76.67%、56.67%、63.33%。A组总有效率及iPTH下降水平高于B组及C组(P<0.05);A组治疗后较治疗前Ca值下降(P<0.05);A组血P下降较B组及C组明显(P<0.05);A组治疗后Mg较治疗前下降(P<0.05),A、B组间Mg差异无统计学意义(P>0.05),A组Mg低于C组(P<0.05);A组治疗后AKP较治疗前下降(P<0.05),A、B两组间差异无统计学意义(P>0.05),A、C两组间差异无统计学意义(P>0.05);A组25-(OH)D较治疗前上升(P<0.05),A、B组间差异有统计学意义(P<0.05),A、C组间差异无统计学意义(P>0.05)。血Alb水平在A组治疗前后,A、B组间及A、C组间比较差异均无统计学意义(P>0.05)。治疗3个月后,A组治疗后骨密度T值较治疗前上升(P<0.05),A、B及A、C组间比较差异有统计学意义(P<0.05)。B组治疗3个月后的AACs较治疗前下降(P<0.05)。三组患者治疗3个月后甲状旁腺体积行组间比较,以及A组治疗前后比较差异均未发现统计学意义(P>0.05);三组患者治疗期间各组间总的不良反应发生率比较差异无统计学意义(P>0.05)。结论老年MHD并严重SHPT患者采用拟钙剂、非含钙磷结合剂及维生素D类似物三者联合治疗较两药联合方案具有更好的临床疗效,同时安全性高、不良反应少,值得临床医师参考应用。
objective To investigate the clinical efficacy of combined pharmacotherapy for severe secondary hy-perparathyroidism(SHPT)in elderly patients undergoing maintenance hemodlialysis(MHD),aiming to explore more ef-fective treatment strategies.Methods A total of 90 elderly MHD patients with severe SHPT admitted to the hemodialysis unit of our hospital from January 2023 to August 2023 were selected and randomly divided into three groups(n=30 each)based on baseline serum calcium and phosphorus levels and treatment regimens.Group A received a combination of calcimimetics,non-calcium phosphate binders,and vitamin D analogs.Group B received calcimimetics and non-calcium phosphate binders.Group C received vitamin D analogs and non-calcium phosphate binders.All patients received continuous treatment for three months.Baseline demographic and clinical data were collected.The therapeutic efficacy of the three groups was compared,as well as changes in serum calcium(Ca),serum phosphorus(P),serum magnesium(Mg),intact parathyroid hormone(iPTH),serum albumin(Alb),alkaline phosphatase(AKP),and 25-hydroxy vitamin D[25-(OH)D]levels before and after treatment.Additionally,changes in parathyroid gland volume,bone mineral density T-score,and abdominal aortic calcification scores(AACs)were assessed.Adverse drug reactions were also recorded.Results After 3 months of treatment,all groups showed a decrease in iPTH levels.The total effective rates were 76.67%in Group A,56.67%in Group B,and 63.33%in Group C.Group A had significantly higher efficacy and greater iPTH reduction compared to Groups B and C(P<0.05).Serum Ca decreased significantly in Group A(P<0.05),and the decrease in serum P in Group A was significantly greater than in the other two groups(P<0.05).Serum Mg decreased in Group A(P<0.05),with no difference between Groups A and B(P>0.05),but Group A had lower Mg levels than Group C(P<0.05).AKP decreased significantly in Group A(P<0.05);while no difference was found between Groups A and B(P>0.05)and between Groups A and C(P>0.05).25-(OH)D increased significantly in Group A(P<0.05),with a significant difference between Groups A and B(P<0.05),but not between Groups A and C(P>0.05).There were no significant differences in Alb levels before and after treatment or between groups(P>0.05).Bone mineral density T-scores improved significantly in Group A after treatment(P<0.05),with significant differences when compared with Groups B and C(P<0.05).AACs decreased significantly in Group B after 3 months(P<0.05).No significant change in parathyroid volume was observed within or between groups(P>0.05).The incidence of adverse events was not significantly different among the three groups(P>0.05).Conclusion In elderly MHD patients with severe SHPT,the combination therapy of calcimimetics,non-calcium phosphate binders,and vitamin D analogs demonstrates superior clinical efficacy compared to two-drug regimens.It is safe,with few adverse effects,and is worth promoting in clinical practice.
作者
黄兵
崔向飞
陆苗苗
HUANG Bing;CUl Xiang-fei;LL Mino-mino(Depart-ment of Nephrology,the First Affiliated Hospital of Jinzhou Medical University,Jinzhou 121001,Liaoning,China)
出处
《广东医学》
2025年第5期738-746,共9页
Guangdong Medical Journal
基金
辽宁省科学技术计划项目(2022-MS-383)。
