Department of Internal Medicine, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki, Yokohama, Kanagawa, 2248503, Japan.
Clin Exp Nephrol. 2012 Apr;16(2):292-9. doi: 10.1007/s10157-011-0547-5. Epub 2011 Oct 20.
Cinacalcet has been shown to be effective in lowering serum intact parathyroid hormone (iPTH) levels in patients with advanced secondary hyperparathyroidism (SHPT). We investigated clinical factors influencing therapeutic response to cinacalcet for SHPT refractory to active vitamin D sterols.
A total of 57 hemodialysis patients with SHPT (iPTH >300 pg/mL) were enrolled in this 28-week, prospective, observational study. Cinacalcet was started at an initial dose of 25 mg/day; the dose of cinacalcet was titrated to achieve the following: 3.5 ≤ phosphate (P) ≤ 6.0 mg/dL; 8.4 ≤ adjusted calcium (Ca) ≤ 10.0 mg/dL; 60 ≤ iPTH ≤ 180 pg/mL). Parathyroid ultrasonographic examination was performed at the start of cinacalcet treatment. Patients were divided into two groups on the basis of iPTH levels after 28 weeks: Group A, iPTH ≤180 pg/mL; Group B, iPTH >180 pg/mL.
Serum iPTH and P levels at baseline were significantly higher in Group B than Group A. The number of enlarged parathyroid glands (PTGs) (estimated volume ≥500 mm(3) or major axis ≥10 mm), which presumably had nodular hyperplastic lesions, and the largest and the total volume of detectable PTGs were significantly greater in Group B compared with Group A. In our multivariate logistic regression analysis, patients with two or more enlarged PTGs had a significant risk of poor response to cinacalcet treatment (odds ratio 5.68, 95% confidence interval 1.19-32.66, P = 0.0363).
These results indicate that the number of enlarged PTGs could predict therapeutic response of cinacalcet in patients with advanced SHPT.
西那卡塞已被证明可有效降低晚期继发性甲状旁腺功能亢进症（SHPT）患者的血清全段甲状旁腺激素（iPTH）水平。我们研究了影响对活性维生素 D 固醇难治性 SHPT 应用西那卡塞治疗反应的临床因素。
共有 57 例 SHPT（iPTH＞300 pg/mL）血液透析患者参与这项为期 28 周的前瞻性观察性研究。西那卡塞起始剂量为 25 mg/天；调整西那卡塞剂量以达到以下目标：3.5≤血磷（P）≤6.0 mg/dL；8.4≤校正钙（Ca）≤10.0 mg/dL；60≤iPTH≤180 pg/mL）。在开始使用西那卡塞治疗时进行甲状旁腺超声检查。根据 28 周后 iPTH 水平将患者分为两组：A 组，iPTH≤180 pg/mL；B 组，iPTH＞180 pg/mL。
B 组患者的血清 iPTH 和 P 水平在基线时明显高于 A 组。B 组患者中估计体积≥500 mm（3）或长轴≥10 mm 的增大甲状旁腺（PTG）（假定存在结节性增生病变）数量、最大和可检测到的 PTG 总容积明显大于 A 组。在多变量逻辑回归分析中，存在两个或更多增大的 PTG 患者对西那卡塞治疗的反应不良的风险显著增加（比值比 5.68，95%置信区间 1.19-32.66，P=0.0363）。
这些结果表明，增大的 PTG 数量可以预测晚期 SHPT 患者西那卡塞的治疗反应。
