【摘要】 目的 探讨西那卡塞和骨化三醇联合治疗糖尿病肾病(DN)血液透析患者继发性甲状旁腺功能亢进症(SHPT)的临床效果。方法 选择2018年6月至2020年4月平顶山市第一人民医院收治的128例DN血液透析SHPT患者为研究对象，根据治疗方案将患者分为观察组和对照组，每组64例。2组患者均给予碳酸氢盐透析液标准化血液透析治疗，在血液透析治疗基础上，对照组患者给予盐酸西那卡塞片治疗，观察组患者给予盐酸西那卡塞片和骨化三醇联合治疗，2组患者均治疗6个月。治疗前及治疗3、6个月，检测2组患者血钙、血磷、血尿素氮(BUN)、血肌酐(Scr)及血清骨保护素(OPG)、成纤维细胞生长因子23(FGF-23)、全段甲状旁腺激素(iPTH)水平，采用尿素动力学模式计算尿素清除指数(KT/V),应用颈部超声波测量甲状旁腺体积。治疗6个月后评估2组患者的临床疗效，治疗期间观察2组患者不良反应发生情况。结果 2组患者治疗前血钙、血磷水平及钙磷乘积比较差异无统计学意义(P>0.05);2组患者治疗3、6个月后血钙水平显著高于治疗前，血磷水平、钙磷乘积显著低于治疗前(P<0.05);2组患者治疗6个月后血钙水平显著高于治疗3个月，血磷水平、钙磷乘积显著低于治疗3个月(P<0.05);治疗3、6个月后，观察组患者血钙水平显著高于对照组，血磷水平、钙磷乘积显著低于对照组(P<0.05)。2组患者治疗前血清OPG、FGF-23水平比较差异无统计学意义(P>0.05);2组患者治疗3、6个月后血清OPG、FGF-23水平显著低于治疗前(P<0.05),2组患者治疗6个月后血清OPG、FGF-23水平显著低于治疗3个月(P<0.05);治疗3、6个月后，观察组患者血清OPG、FGF-23水平显著低于对照组(P<0.05)。2组患者治疗前BUN、Scr水平及KT/V比较差异无统计学意义(P>0.05);2组患者治疗3、6个月后BUN、Scr水平及KT/V与治疗前比较差异无统计学意义(P>0.05);2组患者治疗6个月后BUN、Scr水平及KT/V与治疗3个月后比较差异无统计学意义(P>0.05);治疗3、6个月后，2组患者BUN、Scr水平及KT/V比较差异无统计学意义(P>0.05)。2组患者治疗前甲状旁腺体积、血清iPTH水平比较差异无统计学意义(P>0.05);2组患者治疗3、6个月后甲状旁腺体积、血清iPTH水平显著低于治疗前(P<0.05),2组患者治疗6个月后甲状旁腺体积、血清iPTH水平显著低于治疗3个月(P<0.05);治疗3、6个月后，观察组患者甲状旁腺体积、血清iPTH水平显著低于对照组(P<0.05)。观察组和对照组患者治疗总有效率分别为93.75%(60/64)、81.25%(52/64),观察组患者治疗总有效率显著高于对照组(χ~2=4.571,P<0.05)。观察组和对照组患者不良反应发生率分别为10.94%(7/64)、7.81%(5/64),2组患者不良反应发生率比较差异无统计学意义(χ~2=0.368,P>0.05)。结论 西那卡塞和骨化三醇联合治疗可以有效调节DN血液透析SHPT患者的血清iPTH水平，改善骨代谢和钙磷代谢紊乱，缩小甲状旁腺体积。更多还原

【Abstract】 Objective To investigate the effect of cinacalcet and calcitriol in the treatment of secondary hyperparathyroidism(SHPT) in diabetic nephropathy(DN) patients undergoing hemodialysis.Methods A total of 128 DN complicated with SHPT patients who underwent hemodialysis in the First People′s Hospital of Pingdingshan City from June 2018 to April 2020 were selected as the research subjects, and the patients were divided into observation group and control group according to the treatment plan, with 64 cases in each group.The patients in the both groups were treated with bicarbonate dialysate standardized hemodialysis.On the basis of hemodialysis, the patients in the control group were treated with cinacalcet hydrochloride tablets, and the patients in the observation group were treated with cinacalcet hydrochloride tablets and calcitriol.The patients in the both groups were treated for six months.Before treatment and after 3 and 6 months of treatment, the levels of blood calcium calcium, blood phosphorus, blood urea nitrogen(BUN) and serum creatinine(Scr),osteoprotegerin(OPG),fibroblast growth factor 23(FGF-23),intact parathyroid hormone(iPTH) were detected.The urea clearance index(KT/V) was calculated by urea kinetic model, and the volume of parathyroid gland was measured by neck ultrasound.The clinical efficacy of patients in the two groups was evaluated after 6 months of treatment, and the adverse reactions of patients in the two groups were observed during the treatment.Results There was no significant difference in blood calcium, phosphorus levels and calcium-phosphorus product between the two groups before treatment(P>0.05).Compared with before treatment, the blood calcium level of patients in the two groups was significantly increased after 3 and 6 months of treatment, and the blood phosphorus level and calcium-phosphorus product were significantly decreased(P<0.05).Compared with 3 months of treatment, the blood calcium level of patients in the two groups was significantly increased after 6 months of treatment, and the blood phosphorus level and calcium-phosphorus product was significantly decreased(P<0.05).After 3 and 6 months of treatment, the serum calcium level of patients in the observation group was significantly higher than that in the control group, and the blood phosphorus level and calcium-phosphorus product were significantly lower than those in the control group(P<0.05).There was no significant difference in serum OPG and FGF-23 levels between the two groups before treatment(P>0.05).The levels of serum OPG and FGF-23 in the two groups after 3 and 6 months of treatment were significantly lower than those before treatment(P<0.05).The levels of serum OPG and FGF-23 in the two groups after 6 months of treatment were significantly lower than those after 3 months of treatment(P<0.05).The levels of serum OPG and FGF-23 in the observation group were significantly lower than those in the control group after 3 and 6 months of treatment(P<0.05).There was no significant difference in the levels of BUN,Scr and KT/V between the two groups before treatment(P>0.05).There was no significant difference in the levels of BUN,Scr and KT/V between 3,6 months of treatment and before treatment in the two groups(P>0.05).There was no signifi-cant difference in the levels of BUN,Scr and KT/V of patients in the two groups between 6 months of treatment and 3 months of treatment(P>0.05).There was no significant difference in the levels of BUN,Scr and KT/V of patients between the two groups after 3 and 6 months of treatment(P>0.05).There was no significant difference in parathyroid volume and serum iPTH level between the two groups before treatment(P>0.05).The parathyroid volume and serum iPTH level of patients in the two groups after 3 and 6 months of treatment were significantly lower than those before treatment(P<0.05).The volume of parathyroid glands and serum iPTH level in the two groups after 6 months of treatment were significantly lower than those after 3 months of treatment(P<0.05).The parathyroid volume and serum iPTH level in the observation group were significantly lower than those in the control group after 3 and 6 months of treatment(P<0.05).The total effective rate of patients in the observation group and control group was 93.75%(60/64) and 81.25%(52/64),respectively.The total effective rate in the observation group was significantly higher than those in the control group(χ~2=4.571,P<0.05).The incidence of adverse reactions in the observation group and control group was 10.94%(7/64) and 7.81%(5/64),respectively.There was no significant difference in the incidence of adverse reactions between the two groups(χ~2=0.368,P>0.05).Conclusion The combined treatment of cinacalcet and calcitriol can effectively regulate the serum iPTH level in DN patients with SHPT who underwent hemodialysis, improve bone metabolism and calcium and phosphorus metabolism disorders, and reduce the volume of parathyroid.更多还原