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目的研究短期使用盐酸西那卡塞治疗尿毒症并发继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)的长期血透患者的高磷、高钙、高血清全段甲状旁腺激素(intact parathyroid hormone,iPTH)及对血高成纤维细胞生长因子23(fibroblast growth factor-23,FGF-23)、血骨保护素(osteoprotegerin,OPG)的影响。方法选取作者医院血透中心长期行血液透析并发SHPT的患者20例(血钙>2.75 mmol/L,钙磷乘积>4.52 mmol~2/L~2)为研究对象。根据患者血磷、血钙、iPTH水平予以相应口服剂量西那卡塞,疗程4周。4周后停用西那卡塞,检测并分析血磷、血钙、血iPTH、血清FGF-23、血OPG。结果 20名患者均完成全部观察,经西那卡塞治疗4周后,血磷、血钙、血iPTH、血OPG、血FGF-23水平较西那卡塞使用前均减少,且有统计学差异(P<0.01)。血红蛋白(hemoglobin,HGB)、血清白蛋白(albumin,ALB)使用西那卡塞前后变化无统计学差异(P>0.05)。结论西那卡塞可有效纠正慢性肾衰竭患者并发SHPT的高磷、高钙、高iPTH,短期内应用可降低患者血磷、血钙、iPTH、FGF-23、血OPG水平。西那卡塞易出现恶心、呕吐、低钙等不良反映,宜短期服用。
Objective To study the effects of short-term cinacalcet hydrochloride on long-term hemodialysis patients with uremia and secondary hyperparathyroidism (SHPT) parathyroid hormone (iPTH) and its effect on fibroblast growth factor-23 (FGF-23) and osteoprotegerin (OPG). Methods Twenty patients (serum calcium> 2.75 mmol / L, calcium-phosphorus product> 4.52 mmol ~ 2 / L ~ 2) who underwent hemodialysis and long-term hemodialysis were enrolled in this study. According to the patient’s blood phosphorus, blood calcium, iPTH level to the corresponding oral dose of cinacalcet, treatment for 4 weeks. After 4 weeks, cinacalcet was discontinued. Blood phosphorus, serum calcium, blood iPTH, serum FGF-23 and blood OPG were detected and analyzed. Results All the 20 patients completed the observation. After 4 weeks of cinacalcet treatment, the levels of serum phosphorus, serum calcium, blood iPTH, blood OPG and blood FGF-23 were all lower than those before cinacalcet and statistically significant Difference (P <0.01). There was no significant difference in the changes of hemoglobin (HGB) and albumin (ALB) before and after cinacalcetin (P> 0.05). Conclusion Cinacalcet can effectively correct the high phosphorus, high calcium and high iPTH in patients with chronic renal failure complicated with SHPT. Short-term application of cinacalcet can reduce the levels of serum phosphorus, serum calcium, iPTH, FGF-23 and OPG in patients with SHR. Cinacalcet prone to nausea, vomiting, low calcium and other adverse reactions, should take short-term.