目的观察并评价西那卡塞对不同全段甲状旁腺激素(intactparathyroidhormone,iPTH)血液透析合并继发性甲状旁腺功能亢进(secondaryhyperparathyroidism,SHPT)的患者长期疗效，为临床治疗提供依据。方法回顾性分析2010年5月～2019年8月好大夫在线张凌医生网站线上诊疗及北京市垂杨柳医院肾内科血液透析室的47例SHPT患者，根据治疗起始iPTH值分为A组(iPTH＜800pg/ml)和B组(iPTH≥800pg/ml)，观察应用西那卡塞治疗12月后，2组患者在血钙、血磷、iPTH控制方面的差异。疗效评价标准：iPTH下降≥50%定义为治疗显效：iPTH下降≥30%定义为治疗有效。结果2组患者基线情况除了iPTH和超声检查甲状旁腺增大腺体数目不同以外，其他指标无差异；随着治疗时间延长，血钙达标率在6月A组高于B组(χ2=3.632,P=0.029)，在治疗12月时2组无差异(χ2=1.362,P=0.243)；血磷达标率逐渐上升，但无统计学差异(χ2=5.158、6.000，P=0.076、0.050)；iPTH均值在A组和B组治疗6月及12月时都明显下降(Z=-2.728、-1.852，P=0.003、0.032)；在治疗6月及12月时2组的显效率、有效率无统计学差异(χ2=0.011、0.084、0.869、0.254，P=0.917、0.772、0.351、0.614)；在治疗6月时iPTH≤250pg/ml比例A组高于B组(χ2=5.887,P=0.015)，在治疗12月时A组和B组无差异(χ2=0.510，P=0.475)。结论西那卡塞对于不同iPTH水平的血液透析患者都有疗效，其中iPTH＜800pg/ml组更易达标，iPTH≥800pg/ml组随着治疗时间延长达标率获益。【关键词】维持性血液透析；继发性甲状旁腺功能亢进；西那卡塞
bjective To evaluate the long-term efficacy of cinacalcet in hemodialysis patients with different levels of intact parathyroid hormone (iPTH) and secondary hyperparathyroidism (SHPT), so as to provide the information for clinical treatment of hemodialysis patients with SHPT. Methods A total of 47 SHPT patients treated during May 2010 to August 2019 online by Dr. Zhang Ling on “Well-known Doctor Online” as well as in the Hemodialysis Center, Department of Nephrology, Beijing Chuiyangliu Hospital were retrospectively analyzed. According to the baseline iPTH value, they were divided into two groups: <800pg/ml (group A) and ≥800pg/ml (group B). After cinacalcet therapy for 12 months, differences in serum calcium, phosphorus and iPTH were analyzed between the two groups. A decrease of iPTH ≥50% was defined as significant effective, and a decrease of iPTH≥30% was defined as effective. Results There were no differences in baseline indicators except iPTH level and the number of enlarged parathyroid glands by ultrasound examination between the two groups. Along with the cinacalcet treatment time, the compliance rate of serum calcium was higher in group A than in group B at the 6th month of the treatment (χ2=3.632, P=0.029) and had no difference between the two groups at the 12th month of the treatment (χ2=1.362, P=0.243); the compliance rate of serum phosphorus increased gradually, but had no statistical difference between the two groups at the 6th month and 12th month of the treatment (χ2=5.158 and 6.000, respectively; P=0.076 and 0.050, respectively); the mean iPTH value decreased significantly in both groups at the 6th month and 12th month of the treatment (Z=-2.728 and -1.852, respectively; P=0.003, 0.032), and there were no statistical differences in significant effective rate and effective rate between the two groups at the 6th month and 12th month of the treatment (χ2=0.011, 0.084, 0.869 and 0.254, respectively; P=0.917, 0.772, 0.351 and 0.614, respectively). The rate of iPTH decreased to ≤250pg/ml was higher in group A than in group B at the 6th month of the treatment (χ2=5.887, P=0.015) but had no difference between the two groups at the 12th month of the treatment (χ2=0.510, P=0.475). Conclusion Cinacalcet was effective in hemodialysis patients with different iPTH levels. The patients with iPTH <800pg/ml were more likely to reach the compliance level. Those with iPTH≥800pg/ml could also reach the compliance level with the extension of treatment course, suggesting that long-term use of cinacalcet can be beneficial even if parathyroid surgery was not available
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