| 韩媛媛,张菁菁,穆福娜依,冒智捷,张 丽.西那卡塞联合碳酸司维拉姆对血液透析并发继发性甲状旁腺功能亢进患者钙磷代谢、FGF23/Klotho轴和心血管事件的影响[J].,2022,(7):1277-1281 |
| 西那卡塞联合碳酸司维拉姆对血液透析并发继发性甲状旁腺功能亢进患者钙磷代谢、FGF23/Klotho轴和心血管事件的影响 |
| Effects of Cinacalcet Combined with Sevelamer Carbonate on Calcium and Phosphorus Metabolism, FGF23/Klotho Axis and Cardiovascular Events in Patients with Hemodialysis Complicated with Secondary Hyperparathyroidism |
| 投稿时间：2021-11-22 修订日期：2021-12-20 |
| DOI：10.13241/j.cnki.pmb.2022.07.017 |
| 中文关键词: 西那卡塞 碳酸司维拉姆 血液透析 甲状旁腺功能亢进 钙磷代谢 FGF23/Klotho轴 心血管事件 |
| 英文关键词: Cinacalcet Sevelamer carbonate Hemodialysis hyperparathyroidism Calcium and phosphorus metabolism FGF23/Klotho axis Cardiovascular events |
| 基金项目:国家自然科学基金项目（81960145） |
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| 中文摘要: |
| 摘要 目的：观察西那卡塞联合碳酸司维拉姆对血液透析并发继发性甲状旁腺功能亢进（SHPT）患者钙磷代谢、成纤维细胞生长因子23（FGF23）/Klotho轴和心血管事件的影响。方法：选取2018年3月-2020年5月新疆医科大学第一附属医院收治的200例血液透析并发SHPT患者，根据随机数字表法分成观察组（n=100）与对照组（n=100）。对照组患者接受碳酸司维拉姆治疗，观察组患者接受西那卡塞联合碳酸司维拉姆治疗，两组患者均连续治疗3个月。观察两组疗效以及钙磷代谢指标、全段甲状旁腺激素（iPTH）、甲状旁腺体积、FGF23、Klotho水平变化，记录治疗期间发生的心血管事件。结果：观察组的临床总有效率较对照组高（P<0.05）。治疗后两组血钙升高，血磷、钙磷乘积下降（P<0.05），且观察组治疗后血钙较对照组高，血磷、钙磷乘积较对照组低（P<0.05）。两组治疗后血清iPTH水平下降，甲状旁腺体积缩小，且观察组的变化程度较对照组大（P<0.05）。两组治疗后Klotho水平升高，FGF23水平下降，且观察组的变化程度大于对照组（P<0.05）。观察组的非致死性心血管事件发生率明显低于对照组（P<0.05）。结论：西那卡塞联合碳酸司维拉姆治疗血液透析并发SHPT患者疗效显著，可调节钙磷代谢，降低血清iPTH水平，缩小甲状旁腺体积，调节Klotho、FGF23水平，降低非致死性心血管事件发生率。 |
| 英文摘要: |
| ABSTRACT Objective: To observe the effects of cinacalcet combined with sevelamer carbonate on calcium and phosphorus metabolism, fibroblast growth factor-23 (FGF23) / Klotho axis and cardiovascular events in patients with hemodialysis complicated with secondary hyperparathyroidism (SHPT). Methods: 200 patients with hemodialysis complicated with SHPT who were treated in The First Affiliated Hospital of Xinjiang Medical University from March 2018 to May 2020 were aelected, and they were randomly divided into observation group (n=100) and control group (n=100) by the random number table method. The patients in the control group were treated with sevelamer carbonate, and the patients in the observation group were treated with cinacalcet combined with sevelamer carbonate. Both groups were treated continuously for 3 months. The curative effect, calcium and phosphorus metabolism, intact parathyroid hormone (iPTH), parathyroid volume, FGF23, Klotho levels change were observed in two groups, the cardiovascular events during treatment were recorded. Results: The total clinical effective rate in the observation group was significantly higher than that in the control group (P<0.05). After treatment, blood calcium in two groups increased, and blood phosphorus and calcium phosphorus product decreased (P<0.05). After treatment, blood calcium level in observation group was higher than that in control group, and blood phosphorus and calcium phosphorus product were lower than that in control group (P<0.05). After treatment, serum iPTH decreased, and parathyroid volume decreased in the two groups, and the degree of change in the observation group was greater than that in the control group (P<0.05). After treatment, Klotho level increased, and FGF23 level decreased in the two groups, and the degree of change in the observation group was greater than that in the control group (P<0.05). The incidence of non-fatal cardiovascular events in the observation group was significantly lower than that in the control group (P<0.05). Conclusion: Cinacalcet combined with sevelamer carbonate has significant efficacy in the treatment of patients with hemodialysis complicated with SHPT, which can regulate calcium and phosphorus metabolism, reduce the serum iPTH level, reduce the parathyroid volume, regulate the Klotho and FGF23 levels, and reduce the incidence of non-fatal cardiovascular events. |
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