目的 探討阿法骨化醇聯(lián)合復(fù)方α酮酸片治療腎性繼發(fā)性甲狀旁腺功能亢進(jìn)癥的臨床研究。方法 選擇2019年7月—2021年12月在宣城市中心醫(yī)院治療的90例患者，隨機(jī)分對(duì)照組（45例）和治療組（45例）。對(duì)照組患者隨餐口服復(fù)方α酮酸片，6片/次，3次/d。治療組在對(duì)照組的基礎(chǔ)上口服阿法骨化醇軟膠囊，0.5 μg/次，1次/d。兩組治療5周。觀察兩組患者臨床療效，比較治療前后兩組患者癥狀改善時(shí)間，血鈣和血磷水平，甲狀腺激素游離三碘甲狀腺原氨酸（FT3）、游離甲狀腺素（FT4）和促甲狀腺素（TSH）水平，血清因子甲狀旁腺激素（PTH）、腫瘤壞死因子-α（TNF-α）、白細(xì)胞介素-6（IL-6）和C反應(yīng)蛋白（CRP）水平，及不良反應(yīng)情況。結(jié)果 治療后，治療組臨床有效率為97.78%，明顯高于對(duì)照組的80.00%（P<0.05）。治療后，治療組骨骼疼痛、四肢肌力減弱、皮膚瘙癢等癥狀改善時(shí)間均早于對(duì)照組（P<0.05）。治療后，兩組血鈣明顯升高，而血磷、鈣磷乘積指標(biāo)明顯降低（P<0.05）；且治療組的血鈣指標(biāo)高于對(duì)照組，血磷、鈣磷乘積指標(biāo)均明顯低于對(duì)照組（P<0.05）。治療后，兩組FT3、FT4水平明顯降低，而TSH水平明顯升高（P<0.05），且治療組甲狀腺激素水平明顯好于對(duì)照組（P<0.05）。治療后，兩組患者血清因子IL-6、PTH、TNF-α、CRP水平明顯下降（P<0.05），且治療組明顯低于對(duì)照組（P<0.05）。治療期間，治療組不良反應(yīng)率（6.67%）明顯低于對(duì)照組15.56%（P<0.05）。結(jié)論 阿法骨化醇軟膠囊聯(lián)合復(fù)方α酮酸片治療腎性繼發(fā)性甲狀旁腺功能亢進(jìn)癥效果確切，能有效改善臨床癥狀，可調(diào)節(jié)腎功能，糾正患者甲狀旁腺激素，安全有效。

Objective To study the clinical effect of alfacalcidol combined with Compound α-Ketoacid Tablets in treatment of renal secondary hyperparathyroidism. Methods Patients (90 cases) with renal secondary hyperparathyroidism in Xuancheng City Central Hospital from July 2019 to December 2021 were randomly divided into control (45 cases) and treatment (45 cases) group. Patients in the control group were po administered with Compound α-Ketoacid Tablets, 6 tablets/time, three times daily. Patients in the treatment group were po administered with Alfacalcidol soft Capsules on the basis of the control group, 0.5 μg/time, once daily. Patients in two groups were treated for 5 weeks. After treatment, the clinical evaluation was evaluated, the improvement time of symptoms, the levels of blood calcium, blood phosphorus and calcium phosphorus product, FT3, FT4 and TSH, the levels of IL-6, PTH, TNF-α and CRP, and the adverse reactions in two groups before and after treatment were compared. Results The effective rate of the treatment group was 97.78%, which was higher than that of the control group (80.03%, P<0.05). After treatment, the improvement time of bone pain, weakening of muscle strength of extremities and skin pruritus in the treatment group was earlier than that in the control group (P < 0.05). After treatment, blood calcium was significantly increased, while blood phosphorus and calcium-phosphorus product were significantly decreased in two groups (P < 0.05), and these indexes in the treatment group were significantly better than those in the control group (P < 0.05). After treatment, the levels of FT3 and FT4 in two groups were significantly decreased, while the level of TSH were significantly increased (P < 0.05), and the level of thyroid hormone in the treatment group was significantly better than that in the control group (P < 0.05). After treatment, the levels of serum factors IL-6, PTH, TNF-α and CRP in two groups were significantly decreased, and which in the treatment group were significantly lower than those in the control group (P < 0.05). During the treatment, the adverse reaction rate in the treatment group (6.67%) was significantly lower than that in the control group (15.56%) (P < 0.05). Conclusion Alfacalcidol combined with Compound α-Ketoacid Tablets are effective in the treatment of clinical symptoms, can regulate renal function and correct parathyroid hormone, which is safe and effective.

R976

慢病防治聯(lián)合基金立項(xiàng)項(xiàng)目（MBLHJJ202008）