摘要目的 观察小剂量西那卡塞治疗血液透析患者重度继发性甲状旁腺机能亢进症(secondary hyperparathyroidism,SHPT)的疗效与安全性.方法 选取我院血液透析中心接受维持性血液透析治疗＞5年的重度SHPT患者12例,其中男6例,女6例,年龄(46.2±10.2)岁.给予口服西那卡塞25～50 mg/d,比较治疗前后全段甲状旁腺激素(intact parathyroid hormone,iPTH)、血钙(serum calcium,SCa)、血磷(sorum phosphorus,SP)、碱性磷酸酶(alkaline phosphatase,ALP)、甲状旁腺体积,观察治疗前后临床症状改善情况.结果 12例患者基线iPTH为(1419.92±560.58)pg/ml,SCa为(2.35±0.19) mmol/L,SP为(1.86±0.57) mmol/L,ALP为(383.55±381.79) U/L.治疗3月后iPTH为(651.69±386.98) pg/ml,较治疗前明显下降(P=0.009);治疗1个月后SCa为(2.17±0.19) mmol/L,与治疗前相比明显下降(P=0.011);治疗前后SP差异无统计学意义(P=0.389);治疗6个月后ALP为(161.66±143.93)U/L,较治疗前明显下降(P=0.043);治疗后有8例(66.7％)患者甲状旁腺体积较治疗前缩小近50％,患者临床症状明显缓解,1年后上述指标保持稳定,无严重不良反应发生.结论 小剂量西那卡塞治疗血液透析患者重度继发性甲状旁腺机能亢进症效果确切,安全性良好,值得临床推广.

abstractsObjective To observe the efficacy and safety of low dose cinacalcet on severe secondary hyperparathyroidism (SHPT) patients with maintenance hemodialysis.Methods A total of 12 patients with severe SHPT on maintenance hemodialysis more than 5 years in our hospital were enrolled in this study,including 6 males and 6 females,aged(46.2 ± 10.2) years.After oral administration of cinacalcet 25-50 mg/d,the level of iPTH,serum calcium (SCa),serum phosphorus (SP),alkaline phosphatase (ALP),and parathyroid volume before and after treatment were detected.Clinical symptoms before and after treatment was compared.Results The baseline characteristics of the patients were iPTH(1419.92 ± 560.58)pg/ml,SCa (2.35 ± 0.19) mmol/L,SP (1.86 ± 0.57) mmol/L,ALP (383.55 ± 381.79) U/L.After 3 months of cinacalcet treatment,the level of iPTH was (651.69 ± 386.98) pg/ml,which was significantly lower than before cinacalcet treatment(P =0.009).After 1 month of treatment,the levels of SCa were (2.17 ± 0.19) mmol/L,which was significantly lower than before cinacalcet treatment(P =0.011).There was no significant difference in SP before and after cinacalcet treatment(P =0.389).After 6 months of treatment,the levels of ALP were (161.66 ± 143.93) U/L,which was significantly lower than before cinacalcet treatment (P =0.043).In 8 patients(66.7％),the volume of parathyroid gland was reduced by nearly 50％ compared with before treatment;the patient's clinical symptoms were significantly relieved,and the above indicators remained stable after 1 year.Meanwhile,no serious adverse reactions occurred.Conclusions Low dose of cinacalcet has a positive effect on hemodialysis patients with severe secondary hyperparathyroidism,which has good safety and clinical promotion value.