Effect of paricalcitol combined with ciracalcet on micro-inflammatory state and alkaline phosphatase and parathyroid hormone levels in patients with uremic secondary hyperparathyroidism

doi:10.3877/cma.j.issn.1674-0785.2022.11.014

Abstract

Abstract:

Objective

To investigate the effect of paricalcitol combined with ciracalcet on the micro-inflammatory state and alkaline phosphatase (ALP) and parathyroid hormone (iPTH) levels in patients with uremic secondary hyperparathyroidism (SHPT).

Methods

A total of 80 SHPT patients with uremia treated at Yijishan Hospital from June 2019 to December 2020 were selected, and the patients were randomly divided into a combination group (n=40) and a control group (n=40) using the random number table method. The control group was treated with paricalcitol alone, and the combination group was treated with paricalcitol combined with cinacalcet. The treatment lasted for 12 weeks in both groups. The therapeutic effects and the changes in calcium and phosphorus levels, micro-inflammation indicator levels, ALP, iPTH, and parathyroid gland volume between before treatment and 12 weeks after treatment were compared between the two groups.

Results

After 12 weeks of treatment, the total treatment effective rate in the combination group was significantly higher than that of the control group (92.5% vs 75.0%, P＜0.05). Blood calcium, blood phosphorus, and calcium phosphorus product in both groups decreased after treatment when compared with the values before treatment (P＜0.05 for all), but the decreasing trend was more obvious in the combination group than in the control group (P＜0.05 for all). Serum levels of interleukin-6, tumor necrosis factor-α, and C reactive protein (CRP) decreased in both groups when compared with those before treatment (P＜0.05 for all), but the decreasing trend was more obvious in the combination group (P＜0.05 for all). Serum ALP and iPTH levels were both lower than those before treatment in the two groups (P＜0.05 for all), but iPTH was significantly lower in the combination group than in the control group [(326.59±38.39) pg/ml vs (483.21±46.56) pg/ml, P＜0.05]. After 12 weeks of treatment, the volume of the parathyroid glands was lower than that before treatment in both groups (P＜0.05 for both), and the volume of the parathyroid glands in the combination group was significantly smaller than that of the control group [(0.79±0.14) mm³ vs (1.08±0.19) mm³, P＜0.05].

Conclusion

Paricalcitol combined with cinacalcet has a significant therapeutic effect on uremic SHPT, which reduces the micro-inflammatory state of the patients and the levels of ALP and iPTH, as well as the volume of the parathyroid glands.

Key words: Uremia, Paricalcitol, Ciracalcet, Hyperthyroidism, Micro-inflammatory state, Alkaline phosphatase, Parathyroid hormone

Chaoqing Gao, Yong Liu, Dongmei Lu, Jun Hu, Hui Li, Jiajun Zhou. Effect of paricalcitol combined with ciracalcet on micro-inflammatory state and alkaline phosphatase and parathyroid hormone levels in patients with uremic secondary hyperparathyroidism[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(11): 1115-1119.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2022.11.014

https://zhlcyszz.cma-cmc.com.cn/EN/Y2022/V16/I11/1115

Figures/Tables 4

References 16

1	Mizobuchi M, Ogata H, Koiwa F. Secondary hyperparathyroidism: pathogenesis and latest treatment [J]. Ther Apher Dial, 2019, 23(4):309-318.
2	夏林玉, 胡清林. 尿毒症继发性甲状旁腺功能亢进外科治疗的对比分析 [J]. 国际外科学杂志, 2021, 48(2):109-114.
3	Levy AR, Xing S, Brunelli SM, et al. Symptoms of secondary hyperparathyroidism in patients receiving maintenance hemodialysis: a prospective cohort study [J]. Am J Kidney Dis, 2020, 75(3):373-383.
4	黄教文, 陈元, 郭胜根. 帕立骨化醇注射液联合低钙透析治疗维持性血液透析高血钙并继发性甲状旁腺功能亢进症的安全性及疗效分析 [J]. 国际泌尿系统杂志, 2021, 41(3):524-528.
5	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.
6	张建荣, 张凌.慢性肾脏病继发性甲旁亢 [M].北京:人民军医出版社, 2009:100-108,59-60.
7	Pasnicu C, Radu PA, Garofil D, et al. Clinical aspects of parathyroid hyperplasia in secondary renal hyperparathyroidism [J]. Chirurgia (Bucur), 2019, 114(5):594-601.
8	亢宁苏, 崔俊, 郑露,等. 西那卡塞联合骨化三醇延缓尿毒症继发性甲状旁腺功能亢进患者血管钙化的疗效 [J]. 西北药学杂志, 2021, 36(2):304-309.
9	Couture G, Laroche M. Improvement in bone involvement of secondary hyperparathyroidism post-parathyroidectomy [J]. Joint Bone Spine, 2020, 87(6):662.
10	程亚芬, 孙丹妮, 许辉,等. 帕立骨化醇治疗维持性血液透析患者继发性甲状旁腺功能亢进的疗效观察 [J]. 国际泌尿系统杂志, 2020, 40(3):402-406.
11	李霞, 李转欢, 郑环英. 帕立骨化醇联合血液灌流治疗血液透析患者继发性甲状旁腺功能亢进症的疗效 [J]. 中国血液净化, 2021, 20(1):38-42.
12	徐彩棉, 夏国宏, 李轶洁,等. 西那卡塞联合骨化三醇注射液治疗维持性血液透析患者中重度继发性甲状旁腺功能亢进的效果观察 [J]. 临床误诊误治, 2021, 34(2):19-24.
13	张育安, 荣冬靖. 司维拉姆联合西那卡塞治疗血液透析并发继发性甲状旁腺功能亢进患者的疗效观察和对成纤维生长因子23的影响 [J]. 国际泌尿系统杂志, 2021, 41(1):139-142.
14	刘敏, 热孜万古力·阿帕尔, 郭杰. 西那卡塞联合骨化三醇治疗尿毒症血液透析继发性甲状旁腺功能亢进的临床研究 [J]. 药物评价研究, 2020, 43(10):2077-2080.
15	王杨, 胡凤琪, 吴慧杰. 维持性血液透析并发继发性甲状旁腺功能亢进患者血Treg、Th17、iPTH、ALP表达特点分析 [J]. 中国医学前沿杂志(电子版), 2019, 11(10):110-113.
16	李富强. 血液透析和腹膜透析对慢性肾衰竭尿毒症患者微炎症状态的影响及与心血管疾病的关系 [J]. 临床内科杂志, 2019, 36(11):748-750.

组别	例数（男/女）	年龄（岁）	透析时间（年）	收缩压（mmHg）	舒张压（mmHg）
联合组	40（24/16）	57.21±9.54	6.58±1.72	152.32±13.72	87.51±8.24
对照组	40（23/17）	56.45±10.42	6.89±1.94	148.56±16.56	86.24±7.65
χ²/t值	0.052	0.340	0.756	1.106	0.714
P值	0.820	0.735	0.452	0.272	0.477

组别	例数（男/女）	年龄（岁）	透析时间（年）	收缩压（mmHg）	舒张压（mmHg）
联合组	40（24/16）	57.21±9.54	6.58±1.72	152.32±13.72	87.51±8.24
对照组	40（23/17）	56.45±10.42	6.89±1.94	148.56±16.56	86.24±7.65
χ²/t值	0.052	0.340	0.756	1.106	0.714
P值	0.820	0.735	0.452	0.272	0.477

组别	例数	血钙（mmol/L）		血磷（mmol/L）		钙磷乘积
组别	例数	治疗前	治疗12周	治疗前	治疗12周	治疗前	治疗12周
联合组	40	2.05±0.17	1.74±0.13^a	1.96±0.15	1.16±0.14^a	3.63±0.35	2.95±0.26^a
对照组	40	2.08±0.21	1.89±0.14^a	1.97±0.13	1.49±0.17^a	3.66±0.43	3.26±0.24^a
t值		0.234	7.579	0.319	9.477	0.342	5.541
P值		0.816	＜0.001	0.751	＜0.001	0.733	＜0.001

组别	例数	血钙（mmol/L）		血磷（mmol/L）		钙磷乘积
组别	例数	治疗前	治疗12周	治疗前	治疗12周	治疗前	治疗12周
联合组	40	2.05±0.17	1.74±0.13^a	1.96±0.15	1.16±0.14^a	3.63±0.35	2.95±0.26^a
对照组	40	2.08±0.21	1.89±0.14^a	1.97±0.13	1.49±0.17^a	3.66±0.43	3.26±0.24^a
t值		0.234	7.579	0.319	9.477	0.342	5.541
P值		0.816	＜0.001	0.751	＜0.001	0.733	＜0.001

组别	例数	IL-6（pg/ml）		TNF-α（pg/ml）		CRP（mg/L）
组别	例数	治疗前	治疗12周	治疗前	治疗12周	治疗前	治疗12周
联合组	40	37.85±5.12	18.94±3.20^a	63.27±6.48	34.68±4.23^a	12.13±2.05	5.28±1.20^a
对照组	40	38.71±6.56	27.75±5.43^a	65.02±7.12	49.87±5.86^a	12.42±2.86	6.97±1.32^a
t值		0.654	8.841	1.150	13.293	0.521	5.992
P值		0.515	＜0.001	0.254	＜0.001	0.604	＜0.001

Please choose a citation manager

Content to export