目的 探讨帕立骨化醇治疗维持性血液透析(maintenance hemodialysis,MHD)伴继发性甲状旁腺功能亢进症患者的临床疗效，分析全段甲状旁腺激素(iPTH)水平与腹主动脉钙化(abdominal aortic calcification,AAC)评分的相关性。 方法 研究纳入2019年4月～2020年6月在北京市海淀医院接受维持性血液透析继发性甲状旁腺功能亢进治疗的门诊患者。在MHD治疗基础上予以静脉帕立骨化醇治疗12周，比较治疗前后的血钙、血磷和iPTH以及AAC评分以评估帕立骨化醇治疗12周的临床疗效，并随访12个月后患者iPTH水平与AAC情况的关系。 结果 入选患者40例(24例男性和16例女性)经帕立骨化醇治疗12周后，患者血磷(t=2.192,P =0.047)、iPTH水平(t=3.026,P=0.014)均低于治疗前，血钙水平较治疗前水平升高(t=4.188,P =0.001)，但仍维持在正常范围内(2.1～2.5 mmol/L)。比较治疗前后iPTH降低情况，应用帕立骨化醇的治疗总有效率达到95%。AAC轻度组、中度组和重度组患者iPTH水平差异具有统计学意义(F =150.400,P＜0.001)，其中重度AAC患者伴有高水平iPTH。随访12个月后的AAC评分较治疗前有所降低，但差异无统计学意义(t=0.504,P =0.617)。 结论 本研究证实帕立骨化醇可显著降低血液透析患者的iPTH和血磷水平，且血钙磷水平始终维持在正常范围内。血液透析患者出现重度腹主动脉钙化，可能与高iPTH水平相关。
Objectives To investigate the clinical efficacy of Paricalcitol in the treatment of maintenance hemodialysis (MHD) patients with secondary hyperparathyroidism (SHPT), and to analyze the correlation between iPTH level and abdominal aortic calcification (AAC) score. Methods A total of 40 MHD patients (24 males and 16 females) with SHPT and received regular hemodialysis at the Hemodialysis Clinic of Beijing Haidian Hospital from April 2019 to June 2020 were included in the study. Intravenous Paricalcitol was administered for 12 weeks in addition to the MHD. AAC score and serum calcium, phosphorus and intact parathyroid hormone (iPTH) were compared before and after Paricalcitol treatment for 12 weeks to assess its clinical efficacy. The relationship between iPTH level and AAC was assessed after the treatment for 12 months. Results After Paricalcitol treatment for 12 weeks, serum phosphorus and iPTH levels were significantly lower than those before treatment (phosphorus: t=2.192, P=0.047; iPTH: t=3.026, P=0.014); serum calcium was higher than that before treatment (t=4.188, P=0.001), but remained within the normal range (2.1～2.5 mmol/L); the overall effective rate of lowering serum iPTH was 95%. Patients with severe AAC had higher serum iPTH, while those with moderate to mild AAC had relatively lower serum iPTH; the differences in serum iPTH among the severe, moderate and mild AAC groups were statistically significant (F=150.400, P＜0.001). After the treatment for 12 months, AAC scores were lower than the baseline levels, but the score differences had no statistical significance (t=0.504, P=0.617). Conclusions Paricalcitol significantly reduced serum iPTH and phosphate levels in MHD patients, and calcium level remained stable within the normal range. Severe AAC may relate to the higher serum iPTH in MHD patients.
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