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目的探讨应用活性维生素D3纠正继发性甲状旁腺功能亢进(SHPT)对维持性血液透析(MHD)患者心脏结构和功能的影响。方法56例MHD患者均符合SHPT诊断标准,采用低钙透析液稳定透析3个月以上,随机分为A组(29例)和B组(27例),测定血钙(Ca)、磷(P)、甲状旁腺素(iPTH)。A组每日午饭中嚼服碳酸钙600mg,B组在此基础上服用活性维生素D3,2～3μg/周,分2～3次于透析后当晚口服,二组连续用药12个月,当Ca>10.2mg/dl或Ca×P≥55mg2/dl2调节药物剂量。分别于实验开始前及6个月、12个月行心脏多普勒超声检查。结果于实验6个月、12个月后,B组iPTH平均值较A组下降明显(P<0.05,P<0.01)。心脏结构和功能比较,治疗前左室肥厚(LVH)、射血分数(EF),舒张早期和舒张晚期二尖瓣口最大血流速度之比(E/A)等指标二组之间差异无统计学意义(P>0.05),治疗6个月、12个月后,A组上述各指标无明显变化(P>0.05,P>0.05),B组随治疗时间的延长上述指标明显好转,差异有统计学意义(P<0.05和P<0.01)。结论活性维生素D3不仅可以减轻MHD患者SHPT,而且有助于改善SHPT患者的心脏结构和功能。
Objective To investigate the effects of active vitamin D3 on cardiac structure and function in patients with maintenance hemodialysis (MHD) after secondary hyperparathyroidism (SHPT). Methods Fifty-six patients with MHD were all eligible for SHPT diagnostic criteria. The patients were divided into group A (n = 29) and group B (n = 27) by dialysis with low calcium dialysis for more than 3 months. Plasma calcium (Ca) ), Parathyroid hormone (iPTH). A group of daily lunch chewing calcium carbonate 600mg, B group on the basis of active vitamin D3, 2 ~ 3μg / week, 2 to 3 times in the evening after dialysis oral administration, two groups of continuous medication for 12 months, when Ca > 10.2 mg / dl or Ca x P> 55 mg2 / dl2. Doppler echocardiography was performed before the start of the experiment and at 6 months and 12 months respectively. Results After 6 months and 12 months, the mean iPTH in group B was significantly lower than that in group A (P <0.05, P <0.01). Comparison of cardiac structure and function, pre-treatment left ventricular hypertrophy (LVH), ejection fraction (EF), early diastolic and mitral valve maximum flow velocity ratio (E / A) and other indicators between the two groups no difference (P> 0.05). After treatment for 6 months and 12 months, there was no significant change in the above indexes in group A (P> 0.05, P> 0.05). The indexes in group B were obviously improved with the prolongation of treatment time, There was statistical significance (P <0.05 and P <0.01). Conclusion Active vitamin D3 can not only reduce the SHPT in MHD patients, but also help to improve the cardiac structure and function of SHPT patients.