Effect of cinacalcet on mineral metabolismand nutritional indexes of patients with maintenance hemodialysis
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摘要:目的 观察西那卡塞对维持性血液透析（MHD）患者矿物质代谢及营养指标的影响。方法 选取苏州大学附属无锡市第九人民医院血液净化中心MHD患者90例，随机分为对照组与观察组，每组45例。对照组采用基础治疗，观察组在基础治疗上加用西那卡塞。比较2组患者治疗前后矿物质代谢及营养指标达标率、营养不良-炎症评分（MIS）。结果 观察组治疗后的血钙、血磷、全段甲状旁腺激素（iPTH）、甘油三酯达标率较治疗前提高，观察组治疗后血钙、iPTH、甘油三酯达标率较对照组更高，差异均有统计学意义（P < 0.05或P < 0.01）。治疗后，对照组MIS评分为（6.22±2.95）分，高于观察组的（4.22±1.82）分，差异有统计学意义（P < 0.01）。结论 西那卡塞可有效改善MHD患者的矿物质代谢水平及营养状况，改善预后，提高生活质量。Abstract:Objective To observe the effect of cinacalcet on mineral metabolism and nutritional indexes of patients with maintenance hemodialysis (MHD).Methods A total of 90 MHD patients in the Blood Purification Center of Wuxi City Ninth People's Hospital Affiliated to Soochow University were selected and randomly divided into observation group and control group, with 45 cases in each group. The control group was treated with basic therapy, and the observation group was treated with cinacalcet on the basis of basic therapy. The standard-reaching rates of mineral metabolism and nutritional indexes as well as Malnutrition-inflammation Score (MIS) were compared before and after treatment in both groups.Results After treatment, the standard-reaching rates of blood calcium, blood phosphorus, intact parathyroid hormone (iPTH) and triglyceride in the observation group were significantly higher than those before treatment, and the standard-reaching rates of blood calcium, iPTH and triglyceride in the observation group were significantly higher than those in the control group (P < 0.05 or P < 0.01). After treatment, the MIS of the control group was (6.22±2.95) points, which was significantly higher than (4.22±1.82) points of the observation group (P < 0.01).Conclusion Cinacalcet can effectively improve the level of mineral metabolism and nutritional status in MHD patients, improve prognosis and enhance the quality of life.
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表 1 2组患者一般资料比较(x±s)[n(%)]
指标 对照组(n=45) 观察组(n=45) 性别 男 32(71.11) 28(62.22) 女 13(28.89) 17(37.78) 年龄/岁 57.20±11.90 57.30±13.30 透析龄/月 81.69±68.73 80.51±61.26 透析频率/(次/周) 2 6(13.33) 4(8.89) 3 39(86.67) 41(91.11) 血管通路 内瘘 40(88.89) 44(97.78) 长期导管 5(11.11) 1(2.22) 体质量指数/(kg/m2) 22.89±4.78 21.80±3.32 原发病 慢性肾炎 23(51.11) 30(66.67) 高血压 8(17.78) 7(15.56) 糖尿病 10(22.22) 5(11.11) 其他 4(8.89) 3(6.66) 
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表 2 2组治疗前后矿物质代谢及营养指标达标率比较[n(%)]
指标 时点 对照组(n=45) 观察组(n=45) 血红蛋白达标 治疗前 16(35.56) 20(44.44) 治疗后 21(46.66) 28(62.22) 血钙达标 治疗前 21(46.66) 24(53.33) 治疗后 28(62.22) 39(86.67)*# 血磷达标 治疗前 19(42.22) 15(33.33) 治疗后 24(53.33) 31(68.89)* iPTH达标 治疗前 17(37.78) 15(33.33) 治疗后 19(42.22) 37(82.22)*## 血清白蛋白达标 治疗前 42(93.33) 40(88.89) 治疗后 41(91.11) 43(95.56) 总胆固醇达标 治疗前 28(62.22) 25(55.56) 治疗后 26(57.78) 30(66.67) 甘油三酯达标 治疗前 21(46.67) 23(51.11) 治疗后 24(53.33) 35(71.11)*# iPTH: 全段甲状旁腺激素。与治疗前比较, *P < 0.05;与对照组比较, #P < 0.05, ##P < 0.05。
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