Szołkiewicz M, Zdrojewski Z, Sulima-Gillow A, Rutkowski B
Z Kliniki Chorób Nerek Instytutu Chorób, Wewnetrznych Akademii Medycznej, w Gdańsku.
Przegl Lek. 1996;53(5):427-30.
Oral calcitriol pulse therapy slowly becomes a method of choice in the treatment of secondary hyperparathyroidism in hemodialysis patients. It appears to be equally effective and simultaneously significantly cheaper than an intravenous therapy. In last year we have applied such a treatment to 12 hemodialysis patients with severe secondary hyperparathyroidism (iPTH range: 447-1228 pg/ml). All of them were hemodialysed 3 times a week with dialysate Ca+2 level 1.25-1.75 mM/l. Calcium carbonate was administered to maintain serum Ca level between 9.0-11.0 mg/dl and phosphate below 6.0 mg/dl. The patients were given calcitriol at dose 0.1 microgram/kg once a week, but it was obligatory to take a drug at bedtime, at least two hours after the last meal, a day before hemodialysis. During the treatment we divided the patients into two groups: I-patients who responded to our treatment (7/12); II-treatment was unsuccessful (5/12). In this group we decided to increase the dose of calcitriol to 0.075 micrograms/kg twice a week after 6 months use of a previous one. We have achieved statistically significant decrease of parathormone (p < 0.001) and alkaline phosphatase (p < 0.02) in group I and after the increase the dose of calcitriol there occurred the decrease of parathormone (p < 0.05) and alkaline phosphatase (p < 0.002) in group II. Simultaneously we have observed a great clinical improvement. Our results confirm the fact that even severe secondary hyperparathyroidism can be successfully treated with oral calcitriol pulse therapy. Administering of high doses of calcitriol at bedtime increases safety of this procedure-we have not observed any case of hypercalcemia.
口服骨化三醇脉冲疗法正逐渐成为血液透析患者继发性甲状旁腺功能亢进治疗的首选方法。它似乎同样有效，同时比静脉治疗便宜得多。去年，我们对12例严重继发性甲状旁腺功能亢进（iPTH范围：447 - 1228 pg/ml）的血液透析患者采用了这种治疗方法。他们均每周进行3次血液透析，透析液钙水平为1.25 - 1.75 mM/l。给予碳酸钙以维持血清钙水平在9.0 - 11.0 mg/dl之间，磷酸盐低于6.0 mg/dl。患者每周一次，每次以0.1微克/千克的剂量服用骨化三醇，但必须在睡前、最后一餐至少两小时后、血液透析前一天服药。治疗期间，我们将患者分为两组：I组为对治疗有反应的患者（7/12）；II组为治疗失败的患者（5/12）。在II组中，使用之前的剂量6个月后，我们决定将骨化三醇剂量增加至每周两次，每次0.075微克/千克。我们发现I组甲状旁腺激素（p < 0.001）和碱性磷酸酶（p < 0.02）有统计学意义的下降，在增加骨化三醇剂量后，II组甲状旁腺激素（p < 0.05）和碱性磷酸酶（p < 0.002）也出现下降。同时，我们观察到显著的临床改善。我们的结果证实，即使是严重的继发性甲状旁腺功能亢进也可以通过口服骨化三醇脉冲疗法成功治疗。睡前服用高剂量骨化三醇增加了该治疗方法的安全性——我们未观察到任何高钙血症病例。
