陳燕 張英姿 姚霞娟 吳娛 胡宏

[摘要] 目的 探討不同用藥方案對(duì)血透患者繼發(fā)性甲狀旁腺功能亢進(jìn)癥（SHPT）治療的有效性及安全性的影響。 方法 選取本院2019年12月至2020年12月確診的SHPT患者105例作為研究對(duì)象，將其隨機(jī)分為單一藥物組和聯(lián)合藥物組，其中單一藥物組又根據(jù)使用的藥物不同分為司維拉姆組、碳酸鑭組和碳酸鈣組;聯(lián)合藥物組根據(jù)使用的藥物不同分為司維拉姆聯(lián)合西那卡塞組和碳酸鑭聯(lián)合西那卡塞組。經(jīng)過3個(gè)月治療，監(jiān)測(cè)五組患者血鈣、血磷、血甲狀旁腺激素（iPTH）的變化及出現(xiàn)的不良反應(yīng)，綜合評(píng)估診療效果。 結(jié)果 碳酸鈣能夠達(dá)到降磷功效，但藥物治療3個(gè)月后，患者血鈣上升（P>0.05）;服用碳酸鑭、司維拉姆組治療后血鈣、血磷、iPTH水平均有下降趨勢(shì)（P<0.05），其中碳酸鑭組和司維拉姆組血鈣水平低于碳酸鈣組（P>0.05），三組血磷及iPTH水平比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。司維拉姆聯(lián)合西那卡塞組治療后血鈣、血磷、iPTH水平較治療前明顯降低，差異有統(tǒng)計(jì)學(xué)意義（P<0.05），并出現(xiàn)1例肌痛患者;碳酸鑭聯(lián)合西那卡塞組表現(xiàn)出同樣趨勢(shì)，治療后血磷、iPTH水平較治療前降低幅度較大（P<0.05），血鈣并未升高，出現(xiàn)2例不良反應(yīng)患者。 結(jié)論 司維拉姆聯(lián)合西那卡塞及碳酸鑭聯(lián)合西那卡塞可有效降低SHPT患者血磷及iPTH，且沒有高鈣血癥的副作用，碳酸鈣是透析初期患者降磷補(bǔ)鈣的不錯(cuò)選擇，而碳酸鑭和司維拉姆的使用可以更好地延緩血管鈣化進(jìn)程。

[關(guān)鍵詞] 繼發(fā)性甲狀旁腺功能亢進(jìn)癥;血液透析;司維拉姆;碳酸鑭;西那卡塞

[中圖分類號(hào)] R692.5? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] B? ? ? ? ? [文章編號(hào)] 1673-9701（2021）34-0039-05

[Abstract] Objective To explore the effect of different medication regimens on the efficacy and safety of secondary hyperparathyroidism（SHPT） treatment in hemodialysis patients. Methods A total of 105 patients with SHPT diagnosed in our hospital from December 2019 to December 2020 were selected as the study subjects and randomly divided into the single drug group and the combined drug group， in which the single drug group was divided into the sevelamer group， the lanthanum carbonate group and the calcium carbonate group according to different drugs used. The combined drug group was divided into the sevelamer combined with cinacalcet group and the lanthanum carbonate combined with cinacalcet group according to different drugs used. After three months of treatment，the changes in serum calcium， serum phosphorus， serum parathyroid hormone（iPTH），and adverse reactions were monitored in the five groups. The diagnosis and treatment effect was comprehensively evaluated. Results Calcium carbonate could achieve the effect of lowering phosphorus， but after three months of drug treatment，serum calcium increased（P>0.05）. After treatment， the serum calcium， serum phosphorus，and iPTH levels in the lanthanum carbonate and sevelamer group tended to decrease（P<0.05）.The serum calcium level in the lanthanide carbonate group and the sevelamer group was lower than in the calcium carbonate group（P>0.05）. There were no significant difference in serum phosphorus and iPTH levels among the three groups（P>0.05）. After treatment，the serum calcium， serum phosphorus， and iPTH levels in the sevelamer combined with cinacalcet group were significantly lower than those before treatment，and the differences were statistically significant（P<0.05）.And one patient had myalgia. The lanthanum carbonate combined with cinacalcet group showed the same trend. The serum phosphorus and iPTH levels after treatment were significantly lower than those before treatment（P<0.05）. Serum calcium did not increase，and two patients had adverse reactions. Conclusion Sevelamer combined with cinacalcet and lanthanum carbonate combined with cinacalcet can effectively reduce blood phosphate and iPTH in patients with SHPT， without the side effects of hypercalcemia. Calcium carbonate is a good choice for reducing phosphorus and supplementing calcium in patients at the early stage of dialysis， while the use of lanthanum carbonate and sevelamer can better delay the process of vascular calcification.