【摘要】 目的探讨骨化三醇的给药方式对维持性血液透析患者矿物质骨代谢异常的疗效。方法选取2010年1月至2013年4月华中科技大学同济医学院附属荆州医院收治的维持性血液透析患者42例作为研究对象,按照骨化三醇给药方式分为连续给药组(20例)和冲击式给药组(22例),分析治疗前后患者血清中甲状旁腺激素、Ca2+、血磷、血清高敏C反应蛋白的水平、颈动脉内膜厚度以及各指标与颈动脉内膜厚度的相关性。结果治疗后,两组患者的血磷与治疗前比较,差异无统计学意义(P>0.05);两组患者血Ca2+较治疗前均显著升高(P<0.05),但两组间比较差异无统计学意义(P>0.05);冲击给药组患者颈动脉内膜厚度及高敏C反应蛋白水平较治疗前显著降低,但连续给药组患者较治疗前无显著变化;两组患者的甲状旁腺激素水平较治疗前显著降低,且冲击给药组水平低于连续给药组(P<0.05);血清高敏C反应蛋白与颈动脉内膜厚度具有相关关系(r=0.41,P<0.05)。结论对于存在矿物质骨代谢异常的维持性血液透析患者,冲击给予骨化三醇治疗能明显改善患者的微炎症状态,降低甲状旁腺激素水平,提高血清中Ca2+水平,改善颈动脉内膜厚度,其效果优于连续给药。更多还原

【Abstract】 Objective To investigate the effects of different medication modes of calciferol on the treatment for bone metabolism disorder among maintenance hemodialysis patients. Methods A total of 42 maintenance hemodialysis patients with bone metabolism disorder admitted in Jingzhou Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from Jan. 2010 to Apr. 2013 were selected as the research objects. According to the medication modes of calcitriol,the patients were divided into successive medication group( 20 cases) and impulse medication group( 22 cases). Levels of parathyroid hormone,Ca2 +,phosphorus,highsensitivity C reactive protein and thickness of artery tunica intima before and after treatment of the two groups were compared,and the relationship between the indexes and the thickness of artery tunica intima was analyzed. Results After treatment,the blood levels of phosphorus of the two groups had no statistically significant differences than those before treatment( P > 0. 05). The levels of Ca2 +of the two groups were significantly higher than those before treatment( P < 0. 05),but with no statistically significant difference between the two groups( P > 0. 05). The thickness of carotid artery intimal and level of serum high sensitivity C reactive protein of the impulse medication group were lower than those before treatment( P < 0. 05),but those of the successive medication group had no significant differences between before and after treatment( P > 0. 05). The parathyroid hormone levels of the two groups were lower than those before treatment,and that of the impulse medication group was lower than the successive medication group( P < 0. 05). Sensitive C reactive protein and carotid artery intimal thickness showed positive correlation( r =0. 41,P < 0. 05). Conclusion Application of calcitriol by impulse method could improve the micro-inflammatory state of maintenance hemodialysis patients with bone metabolism disorder,lower the level of parathyroid hormone,enhance the level of Ca2 +,improve the arotid artery intimal thickness,and its effect is better than successive medication.更多还原