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目的 比较常规剂量钙三醇与较大剂量冲击疗法防治尿毒症维持性透析患者继发性甲状旁腺功能亢进 (SH PT)的疗效。方法 48例尿毒症透析患者 ,分常规治疗组 (A组 ) 2 2例 ,钙三醇 0 .2 5～ 0 .5 μg·d-1,同时补钙 ,治疗时间 6个月 ;未治疗组 (B组 ) 2 1例 ,皆因经费困难不愿治疗 ;冲击治疗组 (C组 ) 2 1例 (其中 16例来自A组 ) ,钙三醇每周 4μg ,分两次于血透后口服 ,观察 3个月。结果 A组与B组比较 ,血甲状旁腺激素 (PTH)、碱性磷酸酶 (AKP)无明显差别 (P >0 .0 5 ) ,但A组中 ,低血钙、高血磷得到部分纠正 (P <0 .0 5 ) ,骨痛、肌肉抽搐、无力、皮肤瘙痒等症状均有改善 ;A组与C组比较 ,后者低钙、高磷血症被纠正 ,血AKP、PTH明显降低 (takp=2 .0 31,P <0 .0 5 ;tpth=3 .317,P <0 .0 0 1) ,未见高钙血症发生。结论 常规剂量钙三醇不能有效治疗尿毒症血透患者SHPT ;而用较大剂量间歇冲击治疗确能有效控制。
Objective To compare the efficacy of conventional dose of calcitriol with larger dose shock therapy in the prevention and treatment of secondary hyperparathyroidism (SH PT) in uremic patients with maintenance dialysis. Methods 48 cases of uremic dialysis patients, sub-routine treatment group (A group) 22 cases of calcitriol 0. 25 ~ 0. 5 μg · d-1, while calcium, the treatment time of 6 months; untreated group (Group B) 21 patients were reluctant to treat due to financial difficulties; impact treatment group (C group) 21 cases (16 cases from group A), calcitriol 4μg weekly, two times after oral administration in the hemodialysis , Observed for 3 months. Results Compared with group B, there was no significant difference in PTH and AKP between group A and group B (P> 0.05), but in group A, hypocalcemia and hyperphosphatemia got partial Correction (P <0.05), bone pain, muscle twitching, weakness, pruritus and other symptoms have improved; A group and C group, the latter was corrected low calcium, hyperphosphatemia, blood AKP, PTH was significantly (Takp = 2.031, P <0.05; tpth = 3.331, P <0.01), no hypercalcemia occurred. Conclusion Conventional dose of calcitriol can not effectively treat SHPT in patients with uremia hemodialysis and can be effectively controlled by intermittent impact therapy with larger doses.