目的 考察帕立骨化醇注射液聯(lián)合碳酸司維拉姆片治療維持性血透繼發(fā)性甲狀旁腺功能亢進(jìn)癥的臨床療效。方法 選取2020年1月—2022年12月上海交通大學(xué)醫(yī)學(xué)院附屬新華醫(yī)院收治的120例維持性血透繼發(fā)性甲狀旁腺功能亢進(jìn)癥患者作為研究對(duì)象，根據(jù)隨機(jī)數(shù)字表法將所有患者分為對(duì)照組和治療組，每組各60例。對(duì)照組餐中口服碳酸司維拉姆片，0.8 g/次，3次/d；在血液透析結(jié)束后口服骨化三醇軟膠囊，3次/周。治療組餐中口服碳酸司維拉姆片，0.8 g/次，3次/d；在血液透析結(jié)束后靜脈注射帕立骨化醇注射液，1 mL/d。兩組患者持續(xù)給藥8周。觀察治療后臨床療效，比較兩組甲狀旁腺體積、血清指標(biāo)、炎癥因子。結(jié)果 治療后，治療組達(dá)標(biāo)率86.67%，高于對(duì)照組患者的68.33%（P＜0.05）。治療后，兩組甲狀旁腺體積均低于治療前（P＜0.05），且治療組患者甲狀旁腺體積小于對(duì)照組（P＜0.05）。治療后，兩組血清血磷（P）、全段甲狀旁腺素（iPTH）、堿性磷酸酶（AKP）水平均降低，血鈣（Ca）水平升高（P＜0.05），且治療組患者的血清P、iPTH、AKP水平低于對(duì)照組，血清Ca水平高于對(duì)照組（P＜0.05）。治療后，兩組患者血清白細(xì)胞介素-4（IL-4）、C反應(yīng)性蛋白（CRP）水平均顯著降低，血清γ干擾素（IFN-γ）水平顯著升高（P＜0.05），且治療組患者的血清IL-4、CRP水平均低于對(duì)照組，血清IFN-γ水平高于對(duì)照組（P＜0.05）。結(jié)論 帕立骨化醇注射液聯(lián)合碳酸司維拉姆片治療維持性血透繼發(fā)性甲狀旁腺功能亢進(jìn)癥患者療效確切，能夠減小患者甲狀旁腺體積，調(diào)節(jié)體內(nèi)鈣磷代謝等血清因子水平，降低體內(nèi)炎癥因子水平。

Objective To investigate the effect of Paricalcitol Injection combined with Sevelamer Carbonate Tablets in treatment of hyperparathyroidism secondary to maintenance hemodialysis. Methods Patients (120 cases) with hyperparathyroidism secondary to maintenance hemodialysis in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2020 to December 2022 were divided into control and treatment groups according to the random number table method, and each group had 60 cases. Patients in the control group were po administered with Sevelamer Carbonate Tablets during meals, 0.8 g/time, three times daily. And after hemodialysis, patients in the control group were po administered with Calcitriol Soft Capsules, three times weekly. Patients in the treatment group were po administered with Sevelamer Carbonate Tablets during meals, 0.8 g/time, three times daily. And after hemodialysis, patients in the treatment group were iv administered with Paricalcitol Injection, 1 mL/d. Patients in two groups were treated for 8 weeks. After treatment, the clinical efficacies were evaluated, and the parathyroid volume, serum indicators, and inflammatory factors in two groups were compared. Results After treatment, the compliance rate of the treatment group was 86.67%, which was higher than 68.33% of the control group patients (P < 0.05). After treatment, the thyroid volume of two groups was smaller than before treatment (P< 0.05), and the thyroid volume in the treatment group was smaller than that in the control group (P < 0.05). After treatment, the serum levels of P, iPTH, and AKP in two groups were decreased, while the levels of Ca in two groups were increased (P < 0.05). The serum levels of P, iPTH, and AKP in the treatment group were lower than those in the control group, while the serum levels of Ca were higher than those in the control group (P< 0.05). After treatment, the serum levels of IL-4 and CRP in two groups were significantly decreased, while the serum levels of IFN-γ in two groups were significantly increased (P < 0.05). Moreover, the serum levels of IL-4 and CRP in the treatment group were lower than those of the control group, while the serum levels of IFN-γ in the treatment group were higher than those of the control group (P < 0.05). Conclusion Paricalcitol Injection combined with Sevelamer Carbonate Tablets has clinical effect in treatment of hyperpara-thyroidism secondary to maintenance hemodialysis, can reduce the volume of the patient's thyroid, regulate serum factors such as calcium and phosphorus metabolism, and lower the level of inflammatory factors in the body, with high safety.

R977