标题：低钙透析液联合骨化三醇冲击治疗维持性血液透析合并继发性甲状旁腺功能亢进症疗效观察

      作者：徐方，沈渝，齐永灵
    (崇州市人民医院肾内科，四川 崇州 611230)

      卷次： 2016年27卷14期

      【摘要】 目的 观察维持性血液透析合并继发性甲状旁腺功能亢进症(SHPT)采用低钙透析液联合骨化三醇
冲击治疗的疗效。方法 将2013年11月至2015年11月我院血液透析合并SHPT的患者中随机选取132例作为研
究对象。按照简单数字随机表分组法分为观察组和对照组各66例。对照组实施磷钙结合剂与骨化三醇治疗，观察
组实施低钙透析液联合骨化三醇冲击治疗，持续治疗10周。比较两组患者治疗前后的磷、钙水平以及临床症状的
变化情况。结果 观察组患者治疗前的血清中的磷、全段甲状旁腺素(iPTH)水平为(2.52±0.15) mmol/L、(961.22±
62.51) mmol/L2，治疗后为(1.84±0.12) mmol/L、(359.21±45.26) mmol/L2，对照组患者治疗前为(2.57±0.18) mmol/L、
(961.25±62.23) mmol/L2，治疗后为(2.21±0.12) mmol/L、(735.44±60.25) mmol/L2，观察组治疗后磷、iPTH明显低于治
疗前和对照组，差异有统计学意义(P<0.05)，对照组治疗前后差异无统计学意义(P>0.05)；观察组患者治疗前后的钙
水平分别为(2.61±0.25) mmol/L、(2.55±0.24) mmol/L，对照组患者分别为(2.54±0.83) mmol/L、(2.49±0.92) mmol/L，
两组患者治疗前后的钙水平无明显变化，差异无统计学意义(P>0.05)；治疗后观察组中的四肢无力者占 6.06%
(4/66)、骨痛者占 12.12% (8/66)、关节疼痛者占 4.55% (3/66)，皮肤瘙痒者占 10.61% (7/66)，明显低于对照组的
18.18% (12/66)、27.27% (18/66)、16.67% (11/66)、28.79% (19/66)，差异均有统计学意义(P<0.05)；观察组患者出现高
钙与高磷者占 4.55% (3/66)、眩晕恶心者占 3.03% (2/66)、肾功能减退者占 3.03% (2/66)，iPHT浓度过低者占 1.52%
(1/66)，明显低于对照组的 19.70% (12/66)、13.64% (9/66)、9.09% (6/66)、10.61% (7/66)，差异均有统计学意义(P<
0.05)。结论 采用低钙渗析液联合骨化三醇冲击治疗维持性血液透析合并继发性甲状旁腺功能亢进症能显著改
善患者临床症状，减少不良反应发生率，安全性高，值得推荐。

      【关键词】 维持性血液透析；继发性甲状旁腺功能亢进症；低钙透析液；骨化三醇；疗效

      【中图分类号】 R459.5 【文献标识码】 A 【文章编号】 1003—6350（2016）14—2286—03


Effect of low calcium dialysate combined with calcitriol in the treatment of patients with maintenance
hemodialysis complicated with secondary hyperparathyroidism.
XU Fang, SHEN Yu, QI Yong-ling. Department of
Nephrology, Chongzhou Municipal People's Hospital, Chongzhou 611230, Sichuan, CHINA

【Abstract】 Objective To explore the effect of low calcium dialysate combined with calcitriol in the treatment
of patients with maintenance hemodialysis complicated with secondary hyperparathyroidism (SHPT). Methods A total
of 132 patients with hemodialysis combined with SHPT in our hospital from November 2013 to November 2015 were se-
lected as the research subjects. The patients were divided into the observation group (n=66) and the control group (n=66)
according to the simple digital random number table. The control group was treated with calcium-containing phosphate
binder and calcitriol, and the observation group was treated with low calcium dialysate combined with calcitriol therapy,
with the treatment lasted for 10 weeks. The levels of phosphorus, calcium and changes in clinical symptoms were com-
pared between the two groups. Results Before treatment, the phosphorus, intact parathyroid hormone (iPTH) levels in
serum of the observation group were (2.52±0.15) mmol/L, (961.22±62.51) mmol/L2, and those after treatment were
(1.84±0.12) mmol/L, (359.21±45.26) mmol/L2. Before treatment, the phosphorus, iPTH levels in serum of the control
group were (2.57 ± 0.18) mmol/L, (961.25 ± 62.23) mmol/L2, and those after treatment were (2.21 ± 0.12) mmol/L,
(735.44±60.25) mmol/L2. The phosphorus, iPTH of observation group after treatment were significantly lower than those
of before treatment and control group, with no significant difference between before treatment and after treatment of
control group (P>0.05). The calcium levels of observation group before and after treatment were (2.61±0.25) mmol/L,
(2.55 ± 0.24) mmol/L, and the calcium levels of control group before and after treatment were (2.54 ± 0.83) mmol/L,
(2.49±0.92) mmol/L, respectively, with no statistically significant difference before and after treatment in the two groups
(P>0.05). After treatment, the limb weakness, bone pain, joint pain and itch of skin in the observation group were signifi-
cantly lower than those in the control group [6.06% (4/66) vs 18.18% (12/66), 12.12% (8/66) vs 27.27% (18/66), 4.55%
·论 著·
6350.2016.14.017