2023 年第 2 期 第 18 卷

西那卡塞对维持性血液透析伴继发性甲状旁腺功能亢进症患者成纤维细胞生长因子23水平和心血管事件的影响

Effects of cinacalcet on fibroblast growth factor 23 level and cardiovascular events in maintenance hemodialysis patients with secondary hyperparathyroidism

作者：耿兴花1易为2董庆华3向攀3

英文作者：Geng Xinghua1 Yi Wei2 Dong Qinghua3 Xiang Pan3

单位：1首都医科大学附属北京地坛医院顺义院区肾内科，北京101300；2首都医科大学附属北京地坛医院妇产科，北京100015；3首都医科大学附属北京地坛医院肾内科，北京100015

英文单位：1Department of Nephrology Shunyi Branch of Beijing Ditan Hospital Capital Medical University Beijing 101300 China; 2Department of Obstetrics and Gynecology Beijing Ditan Hospital Capital Medical University Beijing 100015 China; 3Department of Nephrology Beijing Ditan Hospital Capital Medical University Beijing 100015 China

关键词：维持性血液透析；继发性甲状旁腺功能亢进症；骨生物标志物；西那卡塞；心血管事件

英文关键词：Maintenancehemodialysis;Secondaryhyperparathyroidism;Bonebiomarker;Cinacalcet;Cardiovascularevents

• 摘要：

• 目的 探讨西那卡塞对维持性血液透析伴继发性甲状旁腺功能亢进症（SHPT）患者成纤维细胞生长因子23（FGF23）水平和心血管事件的影响。方法 前瞻性纳入2018年12月至2021年12月于首都医科大学附属北京地坛医院就诊的100例维持性血液透析伴SHPT患者为研究对象，采用随机数字表法将患者分为西那卡塞组和对照组，每组50例。对照组给予骨化三醇口服常规治疗；西那卡塞组在对照组基础上给予西那卡塞口服治疗。治疗26周后，比较2组患者临床疗效，骨生物标志物FGF23水平，血钙、血磷水平，肾功能以及心血管事件发生情况。结果 治疗后，西那卡塞组总有效率高于对照组［88.0%（44/50）比72.0%（36/50）］（P<0.05）。治疗第9、13、17、26周西那卡塞组FGF23水平均低于对照组（均P<0.05）。治疗第5、9、13、17、26周西那卡塞组血钙、血磷水平均低于对照组（均P<0.05）。治疗前及治疗第5、9、13、17、26周2组患者血尿素氮、血肌酐水平比较均差异无统计学意义（均P>0.05）。治疗第26周西那卡塞组心血管事件累积发生率低于对照组，差异有统计学意义（P<0.05）。结论 西那卡塞治疗维持性血液透析伴SHPT患者疗效显著，可有效维持患者血钙、血磷水平，降低患者FGF23水平及其心血管事件发生率，且不增加患者肾脏负担。

• Objective To investigate the effects of cinacalcet on fibroblast growth factor 23(FGF23) level and cardiovascular events in maintenance hemodialysis patients with secondary hyperparathyroidism(SHPT). Methods  Totally 100 maintenance dialysis patients with SHPT were prospectively enrolled from Beijing Ditan Hospital, Capital Medical University from December 2018 to December 2021. The patients were divided into the cinacalcet group and the control group by the random number table method, with 50 cases in each group. The control group was conventionally treated with calcitriol orally; the cinacalcet group was given cinacalcet orally on the basis of the control group. After 26 weeks of treatment, the clinical efficacy, bone biomarker FGF23 level, serum calcium and phosphorus levels, renal function and cardiovascular events were compared between the two groups. Results  After treatment, the total effective rate in the cinacalcet group was higher than that in the control group［88.0%（44/50） vs 72.0%（36/50）］(P<0.05). At 9, 13, 17, and 26 weeks of treatment, the levels of FGF23 in the cinacalcet group were lower than those in the control group(all P<0.05). The levels of serum calcium and phosphorus in the cinacalcet group were lower than those in the control group at 5, 9, 13, 17, and 26 weeks of treatment(all P<0.05). There were no significant differences in the levels of blood urea nitrogen and serum creatinine between the two groups before treatment and at 5, 9, 13, 17, 26 weeks of treatment(all P>0.05). The cumulative incidence of cardiovascular events in the cinacalcet group was lower than that in the control group at 26 weeks of treatment(P<0.05). Conclusions  Cinacalcet has a significant effect on maintenance hemodialysis patients with SHPT. It can effectively maintain the serum calcium and phosphorus levels, reduce the level of FGF23 and the incidence of cardiovascular events, and does not increase the burden on the renal.