帕立骨化醇对维持性血液透析合并继发性甲状旁腺功能亢进患者心功能的影响

谢伟楠; 刘智

doi:10.16766/j.cnki.issn.1674-4152.002179

帕立骨化醇对维持性血液透析合并继发性甲状旁腺功能亢进患者心功能的影响

doi: 10.16766/j.cnki.issn.1674-4152.002179

谢伟楠¹,
刘智^2, ,

1.
蚌埠医学院研究生院，安徽蚌埠 233000
2.
蚌埠医学院附属淮南市第一人民医院肾脏内科，安徽淮南 232000

基金项目:

安徽省教育厅高校自然科学基金重点项目 KJ2019A0095

蚌埠医学院2018年校级自然科学基金重点项目 BYKY18174

详细信息

通讯作者:
刘智, E-mail: hnsnk@163.com

中图分类号: R459.5 R581.1
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- 文章访问数: 221
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- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2021-03-30
- 网络出版日期: 2022-02-15

The effect of paricalcitol on the cardiac function of secondary hyperparathyroidism patients with maintenance hemodialysis

XIE Wei-nan¹,
LIU Zhi^{2
, ,}

1.
Graduate School of Bengbu Medical College, Bengbu, Anhui 233000, China

摘要

摘要: 目的观察维持性血液透析(MHD)合并继发性甲状旁腺功能亢进(SHPT)患者使用帕立骨化醇后心功能相关参数的变化。方法纳入2019年12月—2020年9月在淮南市第一人民医院接受MHD的40例SHPT患者，收集患者使用帕立骨化醇前的一般资料和全段甲状旁腺激素(iPTH)、钙、磷，以及射血分数(EF)、左室舒张末期内径(LVDd)、室间隔厚度(IVST)、左室后壁舒张末厚度(LVPWT)、左室收缩末期内径(LVDs)、左心房内径(LAD)、缩短分数(FS)、左室心肌质量(LVM)、左室心肌质量指数(LVMI)，比较用药前后上述指标的变化。结果与用药前相比，患者用药后1、3、6个月iPTH明显下降(均P＜0.05)，钙、磷、钙磷乘积水平相对稳定。治疗6个月后，iPTH下降幅度≥50%的患者例数为21例(52.5%)，≥30%的患者有28例(70.0%)。40例患者用药6个月后LVMI、LVM、IVST、LVDd、LVPWT、LVM明显下降(均P＜0.01), FS升高(P＜0.01)，LAD、LVDs、EF未见明显变化(均P＞0.05)。其中LVH组的患者LAD、LVMI、LVM、IVST、LVDd、LVPWT、LVM较前明显下降(均P＜0.05)，FS升高(P < 0.01)，非LVH组的心功能相关参数未见明显变化(均P＞0.05)。结论帕立骨化醇能够明显降低iPTH水平，有效治疗SHPT，对钙、磷及钙磷乘积影响较小，并且能够消退LVH或延缓其进展。
- 帕立骨化醇 /
- 左心室肥厚 /
- 继发性甲状旁腺功能亢进 /
- 血液透析 /
- 慢性肾脏病
Abstract: Objective To observe the changes of cardiac function related parameters in secondary hyperparathyroidism (SHPT) patients with maintenance hemodialysis (MHD) after using paricalcitol. Methods Forty SHPT patients with MHD in Huainan First People's Hospital from December 2019 to September 2020 were included. The clinical data, serum intact parathyroid hormone (iPTH), calcium, phosphorus and heart parameters before the treatment of paricalcitol were collected. The parameters included left ventricular ejection fraction (EF), left ventricular end-diastolic dimension (LVDd), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular end systolic diameter (LVDs), left atrium diameter (LAD), left ventricular fractional shortening (FS), left ventricular mass (LVM) and left ventricular myocardial mass index (LVMI). The changes of the above-mentioned indicators before and after the medication were compared. Results Compared with baseline value, the serum iPTH of SHPT patients decreased significantly at 1, 3, and 6 months after using paricalcitol (P < 0.001), and serum calcium, phosphorus, calcium and phosphorus product levels were relatively stable. After 6 months of paricalcitol treatment, there were 21 SHPT patients (52.5%) whose iPTH decreased by greater than or equal to 50%, and 28 patients (70.0%) whose iPTH decreased by greater than or equal to 30%. After 6 months of paricalcitol treatment, LVMI, LVM, IVST, LVDd, LVPWT of 40 patients decreased significantly, and FS was increased (all P < 0.01). While LAD, LVDs and EF had no change (all P>0.05). The LAD, LVMI, LVM, IVST, LVDd, LVPWT of LVH group patients were also significantly lower than before, and FS was increased (all P < 0.01). While the non-LVH group patients showed no significant change (all P>0.05). Conclusion Paricalcitol can significantly reduce the serum iPTH level, treat SHPT patients with MHD effectively and has fewer adverse effects. It also could subside LVH or delay its progression.
- Paricalcitol /
- Left ventricuslar hypertrophy /
- Secondary hyperparathyroidism /
- Hemodialysis /
- Chronic kidney disease

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表 1 40例MHD合并SHPT患者使用帕立骨化醇前后生化指标的变化(x ±s)

时间	iPTH(ng/L)	钙(mmol/L)	磷(mmol/L)	钙磷乘积(mg²/dL²)
用药前	913.20±409.40	2.35±0.15	1.84±0.25	53.74±7.89
用药后1个月	606.50±321.20^a	2.40±0.20	1.89±0.29	56.43±10.04
用药后3个月	576.60±270.80^a	2.44±0.19^a	1.96±0.31	59.33±11.04^a
用药后6个月	518.70±307.80^a	2.35±0.21	1.81±0.34	53.04±11.85
F值	18.943	3.051	2.244	3.099
P值	< 0.001	0.031	0.087	0.038
注：与用药前比较，^aP＜0.05。

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表 2 40例MHD合并SHPT患者使用帕立骨化醇前后心功能相关参数的变化(x ±s)

时间	LAD(mm)	LVDs(mm)	LVDd(mm)	LVPWT(mm)	IVST(mm)	EF(%)	FS(%)	LVM(g)	LVMI(g/m²)
用药前	35.35±5.28	34.33±2.60	50.10±6.42	12.03±1.39	12.15±1.53	61.80±5.01	32.73±4.56	245.37±77.11	145.99±43.05
用药后6个月	35.28±5.06	34.23±2.57	49.68±6.22	11.65±1.10	11.73±1.24	61.98±5.21	34.43±3.67	229.06±63.10	135.52±34.03
t值	0.684	1.160	3.597	4.050	3.597	-1.125	-6.390	4.315	4.580
P值	0.498	0.253	0.001	< 0.001	0.001	0.268	< 0.001	< 0.001	< 0.001
注：LAD为左心房内径，LVDs为左室收缩末期内径，LVDd为左室舒张末期内径，LVPWT为左室后壁舒张末厚度，IVST为室间隔厚度，EF为射血分数，FS为缩短分数，LVM为左室心肌质量，LVMI为左室心肌质量指数。

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表 3 26例LVH组MHD合并SHPT患者使用帕立骨化醇前后心功能相关参数的变化(x ±s)

时间	LAD(mm)	LVDs(mm)	LVDd(mm)	LVPWT(mm)	IVST(mm)	EF(%)	FS(%)	LVM(g)	LVMI(g/m²)
用药前	37.96±3.70	35.42±1.53	53.38±3.21	12.85±0.88	13.12±0.86	59.54±4.35	30.81±4.12	291.66±45.13	171.71±27.41
用药后6个月	37.77±3.63	35.23±1.61	52.77±3.06	12.27±0.72	12.46±0.81	59.73±4.75	33.04±3.50	266.75±33.15	155.95±19.81
t值	2.440	1.547	3.682	4.573	3.942	-0.817	-7.075	4.901	5.159
P值	0.022	0.134	0.001	< 0.001	0.001	0.422	< 0.001	< 0.001	< 0.001
注：LAD为左心房内径，LVDs为左室收缩末期内径，LVDd为左室舒张末期内径，LVPWT为左室后壁舒张末厚度，IVST为室间隔厚度，EF为射血分数，FS为缩短分数，LVM为左室心肌质量，LVMI为左室心肌质量指数。

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参考文献(19)

[1]	MAJOR R W, CHENG M R I, GRANT R A, et al. Cardiovascular disease risk factors in chronic kidney disease: A systematic review and meta-analysis[J]. PLoS One, 2018, 13(3): e0192895. doi: 10.1371/journal.pone.0192895
[2]	IO H, NAKATA J, INOSHITA H, et al. Relationship among left ventricular hypertrophy, cardiovascular events, and preferred blood pressure measurement timing in hemodialysis patients[J]. J Clin Med, 2020, 9(11): 3512. doi: 10.3390/jcm9113512
[3]	HWANG H S, CHO J S, HONG Y A, et al. Vascular calcification and left ventricular hypertrophy in hemodialysis patients: Interrelationship and clinical impacts[J]. Int J Med Sci, 2018, 15(6): 557-563. doi: 10.7150/ijms.23700
[4]	TAMAYO M, MARTíN-NUNES L, VAL-BLASCO A, et al. Beneficial effects of paricalcitol on cardiac dysfunction and remodelling in a model of established heart failure[J]. Br J Pharmacol, 2020, 177(14): 3273-3290. doi: 10.1111/bph.15048
[5]	MASSIMETTI C, IMPERATO G, FERIOZZI S. Correction of secondary hyperparathyroidism with paricalcitol in renal transplant improves left ventricular hypertrophy[J]. G Ital Nefrol, 2019, 36(1): 2019-vol1. http://www.ncbi.nlm.nih.gov/pubmed/30758155
[6]	王自力, 谢良地. 左心室心肌质量的测量(续一)[J]. 中华高血压杂志, 2008, 16(4): 370-371. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGZ200804028.htm
[7]	张雪琴, 庄晶, 王喻, 等. 帕立骨化醇和骨化三醇治疗血液透析患者继发性甲状旁腺功能亢进症的疗效比较[J]. 中华肾脏病杂志, 2018, 34(10): 778-780. doi: 10.3760/cma.j.issn.1001-7097.2018.10.010
[8]	YETER H H, KORUCU B, BALI E B, et al. Association between calcitriol and paricalcitol with oxidative stress in patients with hemodialysis[J]. Int J Vitam Nutr Res, 2020, 17: 1-8. http://www.researchgate.net/publication/338390043_Association_between_calcitriol_and_paricalcitol_with_oxidative_stress_in_patients_with_hemodialysis_Running_title_Effects_of_vitamin_D_on_oxidative_stress
[9]	MARTíNEZ-ARIAS L, PANIZO S, ALONSO-MONTES C, et al. Effects of calcitriol and paricalcitol on renal fibrosis in CKD[J]. Nephrol Dial Transplant, 2021, 36(5): 793-803. doi: 10.1093/ndt/gfaa373
[10]	BIGGAR P, KOVARIK J, KLAUSER-BRAUN R, et al. Paricalcitol treatment of secondary hyperparathyroidism in hemodialysis patients: A German-Austrian, single-arm, open-label, prospective, noninterventional, observational study[J]. Nephron Clin Pract, 2014, 126(1): 39-50. doi: 10.1159/000357677
[11]	李京, 李霞, 王怡. 帕立骨化醇治疗血液透析患者伴继发性甲状旁腺功能亢进的疗效观察[J]. 中国血液净化, 2019, 18(6): 386-389. doi: 10.3969/j.issn.1671-4091.2019.06.003
[12]	D'AMORE C, MARSICO F, PARENTE A, et al. Vitamin D deficiency and clinical outcome in patients with chronic heart failure: A review[J]. Nutr Metab Cardiovasc Dis, 2017, 27(10): 837-849. doi: 10.1016/j.numecd.2017.07.009
[13]	ZITTERMANN A, ERNST J B. Calciotropic and phosphaturic hormones in heart failure[J]. Nutr Metab Cardiovasc Dis, 2016, 26(11): 971-979. doi: 10.1016/j.numecd.2016.06.007
[14]	PODZOLKOV V I, POKROVSKAYA A E, PANASENKO O I. Vitamin D deficiency and cardiovascular pathology[J]. Ter Arkh, 2018, 90(9): 144-150. http://www.ncbi.nlm.nih.gov/pubmed/30701749
[15]	GLUBA-BRZ ZKA A, FRANCZYK B, CIA KOWSKA-RYSZ A, et al. Impact of vitamin D on the cardiovascular system in advanced Chronic Kidney Disease (CKD) and dialysis patients[J]. Nutrients, 2018, 10(6): 709. doi: 10.3390/nu10060709
[16]	贾静静, 赵劲东, 董平栓, 等. 补充维生素D对心力衰竭患者临床作用的Meta分析[J]. 临床心血管病杂志, 2018, 34(2): 136-141. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB201802009.htm
[17]	SAPONARO F, SABA A, FRASCARELLI S, et al. Vitamin D measurement and effect on outcome in a cohort of patients with heart failure[J]. Endocr Connect, 2018, 7(9): 957-964. doi: 10.1530/EC-18-0207
[18]	COSTANZO S, DE CURTIS A, DI CASTELNUOVO A, et al. Serum vitamin D deficiency and risk of hospitalization for heart failure: Prospective results from the Moli-sani study[J]. Nutr Metab Cardiovasc Dis, 2018, 28(3): 298-307. doi: 10.1016/j.numecd.2017.11.008
[19]	PANDEY A, KITZMAN D W, HOUSTON D K, et al. Vitamin D status and exercise capacity in older patients with heart failure with preserved ejection fraction[J]. Am J Med, 2018, 131(12): 1515. e11-1515. e19. doi: 10.1016/j.amjmed.2018.07.009