目的 观察骨化三醇辅助甲状旁腺微波消融治疗血液透析继发甲状旁腺功能亢进(hyperparathyroidism,SHPT)的临床效果.方法 选取血液透析SHPT患者82例,采用随机数字表法分为对照组(给予甲状旁腺微波消融+盐酸西那卡塞治疗,41例)和观察组(给予甲状旁腺微波消融+盐酸西那卡塞+骨化三醇治疗,41例).比较2组甲状旁腺激素(parathyroid hormone,PTH)、碱性磷酸酶(alkaline phosphatase,ALP)、血磷、血钙水平、临床疗效、甲状旁腺腺体大小、肾功能指标[尿素氮(urea nitrogen,BUN)、血肌酐(serum creatinine,Scr)]、血清骨保护素(osteoprotectin,OPG)、成纤维细胞生长因子 23(fibroblast growth factor 23,FGF-23)水平、不良反应发生情况、术中消融时间和输出功率.结果 治疗后,2组PTH、ALP、血磷水平均低于治疗前,血钙水平高于治疗前,观察组PTH、ALP、血磷水平均低于对照组,血钙水平高于对照组(P<0.05).观察组总有效率血钙水平高于对照组(P<0.05).2组甲状旁腺腺体纵径、横径、体积均低于治疗前,观察组甲状旁腺腺体纵径、横径、体积均低于对照组(P<0.05).治疗后2组BUN、Scr水平比较差异无统计学意义(P>0.05).2组OPG水平低于治疗前,FGF-23水平高于治疗前,观察组OPG、FGF-23水平低于对照组(P<0.05).2组不良反应总发生率差异无统计学意义(P>0.05).2组术中消融时间和输出功率比较差异无统计学意义(P>0.05).结论 骨化三醇辅助甲状旁腺微波消融治疗血液透析SHPT患者效果较好.
Objective To observe the clinical effect of calcitriol assisted parathyroidism microwave ablation in the treatment of secondary hyperparathyroidism(SHPT)undergoing hemodialysis.Methods A total of 82 patients with SHPT undergoing hemodialysis were selected and divided into control group(treated with microwave parathyroid ablation+cinacase hydrochloride,n=41)and observation group(microwave parathyroid ablation+cinacase hydrochloride+calcitriol,n=41).The parathyroid hormone(PTH),alkaline phosphatase(ALP),blood phosphorus,blood calcium levels,clinical efficacy,parathyroid gland size,and renal function indexes[blood urea nitrogen(BUN),serum creatinine(Scr)],serum osteoprotectin(OPG),fibroblast growth factor 23(FGF-23)level,occurrence of adverse reactions,intraoperative ablation time,and output power were compared between two groups.Results After treatment,the levels of PTH,ALP and blood phosphorus in two groups were lower than those before treatment,and the levels of blood calcium were higher than those before treatment.The levels of PTH,ALP and blood phosphorus in the observation group were lower than those in the control group,while the levels of blood calcium were higher than those in the control group(P<0.05).The total effective blood calcium level in observation group was higher than that in control group(P<0.05).The longitudinal diameter,transverse diameter and volume of the parathyroid gland in the two groups were lower than those before treatment,and the longitudinal diameter,transverse diameter and volume of the parathyroid gland in the observation group were lower than those in the control group(P<0.05).There was no significant difference in BUN and Scr levels between two groups after treatment(P>0.05).The level of OPG in the two groups was lower than that before treatment,the level of FGF-23 was higher than that before treatment,and the levels of OPG and FGF-23 in observation group were lower than those in control group(P<0.05).There was no significant difference in the total incidence of adverse reactions between two groups(P>0.05),nor in ablation time and output power between two groups(P>0.05).Conclusion Calcitriol assisted parathyroid microwave ablation is effective in the treatment of SHPT patients undergoing hemodialysis.