Yuan Fang, Chen Xing, Wang Chang, Zhou An, Liu Hong
Department of Nephrology, Second Xiangya Hospital, Central South University; Institute of Nephrology, Central South University, Changsha 410011, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2017 Oct 28;42(10):1169-1173. doi: 10.11817/j.issn.1672-7347.2017.10.007.
To observe the clinical outcome and the effect of the combination of cinacalcet hydrochloride with low-dose calcitriol on bone metabolism in maintenance hemodialysis (MHD) patients with severe secondary hyperparathyroidism (SHPT). Methods: Thirty SHPT patients were enrolled to receive treatment of cinacalcet combined with low-dose calcitriol, with inclusion criteria as follows: maintenance on MHD>6 months; serum intact parathyroid hormone (iPTH)>600 pg/mL; parathyroid glands with more than 1 nodules by ultrasonography; traditional therapy with no effects. All patients were given cinacalcet 25-75 mg and 0.5 μg calcitriol daily. Serum Ca, P, iPTH, bone metabolic markers and bone density were measured before and after treatment. The clinical symptoms and their changes were recorded. Results: The baseline levels of iPTH, Ca and P were (1787.3±1 321.0) pg/mL, (2.54±0.19) mmol/L, and (2.06±0.15) mmol/L, respectively. After 2 weeks of treatment, serum phosphorus decreased by 20%; after 1 and 3 months of treatment, iPTH decreased by 35% and 70%. Ca and P fell to (2.39±0.17) and (1.56±0.50) mmol/L (P<0.05), respectively. The symptoms of the patients relieved. The above indicators remained stable after 12 months. Moreover, after 6 months of treatment, the alkaline phosphatase, osteocalcin and β-cross levels were decreased by 50%, 37% and 49%, respectively. The decline in patients' bone density was inhibited. No severe adverse events were observed. Conclusion: Cinacalcet hydrochloride combined with low dose calcitriol can improve high calcium, high phosphorus and high iPTH in MHD patients with severe SHPT, relieve symptoms, and improve bone metabolism. It can be used as a favorable choice for the treatment of SHPT.
观察盐酸西那卡塞联合小剂量骨化三醇对维持性血液透析（MHD）重度继发性甲状旁腺功能亢进（SHPT）患者骨代谢的临床疗效及影响。方法：选取30例SHPT患者接受西那卡塞联合小剂量骨化三醇治疗，纳入标准如下：维持MHD治疗>6个月；血清全段甲状旁腺激素（iPTH）>600 pg/mL；超声检查甲状旁腺有1个以上结节；传统治疗无效。所有患者每日给予西那卡塞25 - 75 mg及骨化三醇0.5 μg。治疗前后检测血清钙、磷、iPTH、骨代谢标志物及骨密度，并记录临床症状及其变化。结果：iPTH、钙和磷的基线水平分别为（1787.3±1321.0）pg/mL、（2.54±0.19）mmol/L和（2.06±0.15）mmol/L。治疗2周后，血清磷下降20%；治疗1个月和3个月后，iPTH分别下降35%和70%。钙和磷分别降至（2.39±0.17）和（1.56±0.50）mmol/L（P<0.05）。患者症状缓解。12个月后上述指标保持稳定。此外，治疗6个月后，碱性磷酸酶、骨钙素和β-交联水平分别下降50%、37%和49%。患者骨密度下降得到抑制。未观察到严重不良事件。结论：盐酸西那卡塞联合小剂量骨化三醇可改善MHD重度SHPT患者的高钙、高磷和高iPTH状态，缓解症状，改善骨代谢，可作为SHPT治疗的良好选择。
