尿毒症患者不同PTH浓度对阿法D3冲击疗效的影响

Efficacy of different concentration of iPTH on the oral administration α-D3 therapy in uremic patients

  • 摘要: 目的: 观察尿毒症患者不同甲状旁素(PTH)浓度对阿法D3口服冲击治疗效果的影响。方法: 选择我院40例血液透析患者分为冲击组(A组)、常规组(B组),依据iPTH浓度每组再分为2亚组(A1和B1组200pg/m l<iPTH<500Pg/m l,A2和B2组iPTH≥500pg/m l),分别给予阿法D3口服2μg每周2~3和0.25μg 1/d,疗程8周,终点指标iPTH<200pg/m l。检测治疗前、治疗后4周、8周的iPTH、SCa、SP、AKP及肝肾功能。结果: 治疗4周,A1组iPTH下降(201.32±129.87)vs(332.12±131.29),P<0.05,8周iPTH明显下降(152.78±101.21)vs(332.12±131.29),P<0.01;A2组iPTH下降(489.45±119.68)vs(713.34±137.19),P<0.05。A1组iPTH平均下降幅度(60.24±7.93)%,显著大于A2组(31.37±8.63)%。治疗终点达标率A1组明显高于其它组(P<0.01)。碱性磷酸酶 (AKP)A1组和 A2组治疗后均较治疗前明显下降。结论:阿法D3口服冲击疗法对于血透患者中度继发性甲旁亢患者疗效更显著 起效更快。

     

    Abstract: Objective: To observe the efficacy of different concentration of iPTH on oral pulse α-D3therapy in uremia patients.Methods: Forty maintance hemodialysis patients were randomly divided into two groups.According to iPTH level((pg/ml)),each group was divided into two subgroups,A1 and B1group(200<iPTH<500pg/ml),A2 and B2 group(iPTH≥500pg/ml) to receive α-D3either pulse(A1 group 2μg twice or A2 group 2μg thrice weekly)or daily(0.25 μg every day)oral alfacalcidol in a 8weeks course.The therapeutic end-point was iPTH<200pg/ml.The changes of iPTH,SCa,SP,AKP and the functions of liver and kidney were observed before and after treatment of the 4th、 8th weeks.Results: In A1 group,iPTH decreased significantly(201.32±129.87) vs(332.12±131.29l),P<0.05After 4 weeks treatment and more significantly after 8 weeks(152.78±101.21) vs(332.12±131.29),P<0.01;In A2 group,iPTH decreased significantly(489.45±(119.68)) vs(713.34±137.19),P<0.05 after 8 weeks treatment.Mean decrease iPTH in A1 group(60.24±7.93)% was significantly higher then that in A2 group(31.37±8.63)%.The percentage of patients reaching end-point in A1 group was significantly higher than other groups(P<0.01).AKP levels decreased significantly in both A1 and A2 after treatment.Conclusion: The efficacy of oral pulse therapy was superior to those of maintance hemodialysis in moderate secondary hyperparathyroidism patients.

     

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