Vulpio Carlo, Bossola Maurizio, De Gaetano Annamaria, Maresca Giulia, Di Stasio Enrico, Zagaria Luca, Luciani Giovanna, Giordano Alessandro, Castagneto Marco
Institutes of Clinical Surgery, Catholic University of the Sacred Heart, Rome, Italy.
Ther Apher Dial. 2010 Apr;14(2):178-85. doi: 10.1111/j.1744-9987.2009.00781.x.
Cinacalcet efficacy is limited in severe secondary hyperparathyroidism (SHPT) and its effect on parathyroid gland (PTG) volume and morphology have not been sufficiently investigated. We evaluated the effect of cinacalcet treatment for one year on the laboratory parameters of calcium-phosphorus metabolism and PTG ultrasound (US) patterns in hemodialysis (HD) patients with severe SHPT and US results indicative of nodular hyperplasia. Thirteen HD patients with severe SHPT (intact parathyroid hormone >700 pg/mL), US/scintigraphic evidence of at least one PTG with a diameter >7 mm, and high surgical risk or refusal of surgery were included. The patients were treated with cinacalcet. The initial dose of 30 mg was increased up to 180 mg once daily. At baseline and after one year of cinacalcet treatment a neck US was performed, providing data on 22 parathyroid glands in eight patients. The mean diameter at baseline and at one year was 12.6 +/- 5.9 and 13.0 +/- 5.3 mm, respectively (P = 0.46). Similarly, the mean volume at baseline and at one year was 513.4 +/- 416.3 and 556.8 +/- 480.8 mm(3), respectively (P = 0.18). The US structural score remained unchanged in 16 parathyroid glands and increased in 6 (P < 0.03), while the vascular score remained unchanged in 16 parathyroid glands and decreased in 6 (P = 0.25). Thus it can be concluded that cinacalcet treatment for one year in HD patients with severe SHPT is not associated with significant changes in parathyroid gland US patterns.
西那卡塞在严重继发性甲状旁腺功能亢进（SHPT）中的疗效有限，且其对甲状旁腺（PTG）体积和形态的影响尚未得到充分研究。我们评估了西那卡塞治疗一年对严重SHPT且超声（US）结果提示结节性增生的血液透析（HD）患者钙磷代谢实验室参数及PTG超声模式的影响。纳入了13例严重SHPT（完整甲状旁腺激素>700 pg/mL）、US/闪烁扫描显示至少一个PTG直径>7 mm、手术风险高或拒绝手术的HD患者。患者接受西那卡塞治疗。初始剂量30 mg，每日增加至180 mg。在基线和西那卡塞治疗一年后进行颈部US检查，8例患者共提供了22个甲状旁腺的数据。基线时和一年时的平均直径分别为12.6±5.9和13.0±5.3 mm（P = 0.46）。同样，基线时和一年时的平均体积分别为513.4±416.3和556.8±480.8 mm³（P = 0.18）。16个甲状旁腺的US结构评分保持不变，6个增加（P < 0.03），而16个甲状旁腺的血管评分保持不变，6个降低（P = 0.25）。因此可以得出结论，严重SHPT的HD患者接受西那卡塞治疗一年与甲状旁腺US模式的显著变化无关。
