目的 探讨运动管理联合帕立骨化醇对维持性血液透析(maintenance hemodialysis，MHD)患者继发性甲状旁腺功能亢进(secondary hyperparathyroidism，SHPT)的临床疗效及其对成纤维细胞生长因子23(fibroblast growth factor 23，FGF23)-Klotho轴的影响。 方法 40例MHD患者随机等分为帕立骨化醇组(用药组)和运动联合帕立骨化醇组(联合组)。比较2组治疗前(0周)、治疗12周及24周血清钙(Ca)、磷(P)、全段甲状旁腺激素(iPTH)、碱性磷酸酶(ALP)、FGF23及Klotho水平。 结果 干预随着时间的推移，联合组较用药组P、iPTH水平下降(F=4.614、4.144；P=0.038、0.049)，联和组Klotho蛋白升高(F=27.744；P=0.007)，2组Ca、ALP、FGF23比较差异无统计学意义(F=0.004、0.379、0.115；P=0.070、0.542、0.501)。2组在干预前(0周)、干预12周、24周不同时间点上，血清P、iPTH、ALP水平有统计学差异(F=31.395、60.159、38.469，P均＜0.001)且具有下降的趋势，血清Ca(F=21.368,P＜0.001)、Klotho蛋白(F=5.268；P＜0.001)在不同时间点上也具有统计学差异且具有升高的趋势；P、Ca、iPTH、ALP、Klotho蛋白组别与时间之间存在交互效应(F=6.013、0.208、5.321、4.618、5.813；P=0.008、0.013、0.013、0.028、0.013)。FGF23组别与时间之间无交互效应(F=2.637，P=0.645)。 结论 运动联合帕立骨化醇提高Klotho水平，降低P、iPTH水平进而控制SHPT进展。
Objectives To investigate the clinical efficacy of exercise management combined with paricalcitol on secondary hyperparathyroidism (SHPT) and on the fibroblast growth factor 23 (FGF23)-Klotho axis in maintenance hemodialysis (MHD) patients Methods Forty MHD patients were randomly divided into drug group (using paricalcitol) and combined group (using exercise combined with paricalcitol). Serum calcium (Ca), phosphorus (P), intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), FGF23 and Klotho were compared between the two groups before treatment, and after treatment for 12 weeks and 24 weeks. Results Along with the increase of treatment time, serum P and iPTH were lower in combined group than in drug group (F=4.614 and 4.144; P=0.038 and 0.049), Klotho increased in combined group (F=27.744; P=0.007), and serum Ca, ALP and FGF23 had no differences between the two groups (F=0.004, 0.379 and 0.115 respectively; P=0.070, 0.542 and 0.501 respectively). Before the treatment and after the treatment for 12 and 24 weeks, serum P, iPTH and ALP in the two groups showed statistical differences and decrease trend at the three time points (F=31.395, 60.159 and 38.469 respectively; P<0.001), while serum Ca and Klotho in the two groups revealed statistical differences and increase trend at the three time points (F=21.368 and 5.268; P<0.001); there were reciprocal effects between serum levels of P, Ca, iPTH, ALP and Klotho in the two groups and treatment period (F=6.013, 0.208, 5.321, 4.618 and 5.813 respectively; P=0.008, 0.013, 0.013, 0.028 and 0.013 respectively), but serum FGF23 in the two groups and treatment period did not have such reciprocal effect (F=2.637, P=0.645). Conclusions Exercise combined with paricalciferol increased serum Klotho level and decreased serum P and iPTH levels, through which the progressive course of SHPT can be controlled.
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