维生素 D 治疗低甲状旁腺激素血症血液透析患者：哪种选择最佳？

Vitamin D treatment in hemodialysis patients with low serum levels of parathyroid hormone: which is the best choice?

机构信息

Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti - Italy.

出版信息

J Nephrol. 2010 Mar-Apr;23(2):210-5.

PMID:20175051

Abstract

BACKGROUND

This short-term prospective study aimed to assess the effects of treatment with calcidiol (25-hydroxycholecalciferol) or calcitriol in the subset of hemodialysis patients characterized by stable low serum levels of parathyroid hormone (PTH) or affected by hypoparathyroidism after total parathyroidectomy (PTx).

METHODS

Two groups were created according to baseline serum levels of 25-hydroxyvitamin D (25(OH)D): group A (12 patients): <15 ng/mL; group B (12 patients): >15 ng/mL. They underwent a 6-month treatment with oral calcidiol (group A) or oral calcitriol (group B).

RESULTS

Group A showed a statistically significant increase in the serum levels of calcium corrected for serum albumin (cCa), phosphorus (P), total alkaline phosphatases (ALP), PTH and 25(OH)D. Group B showed a statistically significant increase in serum levels of cCa and P. A statistically significant decrease in serum levels of ALP and 25(OH)D was observed. Baseline serum 25(OH)D levels were 12.6 + 3.8 ng/mL in group A and 23.0 + 5.0 ng/mL in group B (p<0.0001). After 6 months, they increased to 38.3 + 21.0 ng/mL in group A (p<0.01) and decreased to 16.9 + 5.8 ng/mL in group B (p<0.01).

CONCLUSIONS

Treatment with oral calcitriol was associated with a decrease in the serum levels of ALP and 25(OH)D; treatment with oral calcidiol was associated with more physiological serum levels of 25(OH)D and with an increase in the serum levels of ALP and PTH: whether the statistically significant differences in the biochemical parameters achieved with the 2 treatments have a clinical relevance, remains a matter of debate.

摘要

背景

本短期前瞻性研究旨在评估钙二醇（25-羟胆钙化醇）或钙三醇治疗在甲状旁腺激素（PTH）水平稳定低或甲状旁腺全切除术后（PTx）发生甲状旁腺功能减退的血液透析患者亚组中的作用。

方法

根据 25-羟维生素 D（25（OH）D）的基线血清水平将两组分为两组：A 组（12 例）：<15ng/mL；B 组（12 例）：>15ng/mL。他们接受了为期 6 个月的口服钙二醇（A 组）或口服钙三醇（B 组）治疗。

结果

A 组血清钙校正白蛋白（cCa）、磷（P）、总碱性磷酸酶（ALP）、PTH 和 25（OH）D 水平有统计学意义的升高。B 组血清 cCa 和 P 水平有统计学意义的升高。ALP 和 25（OH）D 水平有统计学意义的下降。A 组基线血清 25（OH）D 水平为 12.6+3.8ng/mL，B 组为 23.0+5.0ng/mL（p<0.0001）。6 个月后，A 组增至 38.3+21.0ng/mL（p<0.01），B 组降至 16.9+5.8ng/mL（p<0.01）。