Compared With Refractory Secondary Hyperparathyroidism The Short-term Efficacy Of Surgery And Oral Cinacalcet

Objective:1.Understand the pure shock treatment of calcitriol refractory Secondary hyperparathyroidism(Secondary hyperparathyroidism SHPT)patients 6 months of calcium,phosphorus,parathyroid hormone by segment(intact parathyroid hormone iPTH)and calcium-phosphorus product and the improvement of symptoms after treatment,the status of the complications.2.Understand the parathyroid gland all cut method(total parathyroidectomy t-PTX)treatment in patients with refractory SHPT six months of calcium,phosphorus,iPTH and calcium-phosphorus product and the improvement of postoperative symptoms,complications and recurrence rate.3.To understand oral quasi calcium 6 months in patients with refractory SHPT calcium,phosphorus,iPTH and calcium-phosphorus product and the improvement of symptoms after treatment,the status of the complications.4.Compare the t-PTX,oral calcium supplements and pure impact of calcitriol therapy in patients with refractory SHPT six months of calcium,phosphorus,i PTH and calcium-phosphorus product and the improvement of postoperative symptoms,complications and recurrence rate.To evaluate the short-term efficacy of three groups.5.By comparison with curative effect,to guide the treatment of refractory SHPT.Methods:In January 2012 to September 2015 our hospital 118 cases of patients with refractory SHPT,118 cases were performed in patients with refractory SHPT to conventional medical treatment,including low phosphorus diet,adequate hemodialysis or peritoneal dialysis,regular injections of inducing red element and step-down support therapy.Among them,62 cases of patients with refractory SHPT on the basis of routine medical treatment pure impact of calcitriol therapy for group A;26 cases on the basis of routine medical treatment in patients with refractory SHPT t-PTX treatment for group B;30 cases on the basis ofroutine medical treatment in patients with refractory SHPT oral calcium for group C.The above patient clinical data were retrospectively analyzed.Three groups of patients to complete treatment,1 day,the first 1 month before,the first 3 months,the first 6 months of calcium,phosphorus and the calcium-phosphorus product,iPTH,the improvement of postoperative symptoms,complications,and postoperative recurrence rate of follow-up.Results:1.62 pure impact of calcitriol therapy in patients with refractory SHPT day 1,the first of January,the first 3 months,the first 6 months of calcium,phosphorus,parathyroid hormone by segment and calcium-phosphorus product and five difference before treatment.Within 1 month after treatment symptoms period was 25.80%,the symptoms within 1 month period was 24.19%,3 months symptoms period was 12.90%,symptoms within 6 month period was 3.22%.6 month 2 cases of spontaneous fracture and1 case of urinary tract calculi patients.2.26 on the basis of routine medical treatment in patients with refractory SHPT t-PTX treatment day 1,the first of January,march,the first6 months of phosphorus,the first segment product of parathyroid hormone,calcium phosphate and preoperative statistically significant;The first 1 month after treatment,the first 3 months,the first 6 months of calcium and preoperative statistically significant;1day after the treatment of calcium and preoperative no statistical difference.Within 1month after treatment symptoms period was 96.15%,the symptoms within 1 month period was 96.15%,3 months symptoms period was 92.30%,symptoms within 6 month period was 92.30%.Postoperative 1 month have obvious extremities numbness symptoms,2cases with no other complications.Six months have 1 case of recurrence,the recurrence rate was 3.84%.3.30 on the basis of routine medical treatment in patients with refractory SHPT oral calcium day 1,the first 1 month in June,the first 3 months,the first of calcium,phosphorus,parathyroid hormone by segment and calcium-phosphorus product and preoperative statistically significant.Within 1 month after treatment symptoms period was86.67%,the symptoms within 1 month period was 83.33%,3 months symptoms period was 66.67%,symptoms within 6 month period was 60.00%.After six months of obvious extremities numbness symptoms in 2 patients,no other complications.4.Group B and group C compared with group A calcium-phosphorus product point of phosphorus and the calcium-phosphorus product,serum parathyroid hormone by segment(intact parathyroid hormone iPTH)were significantly lower(P < 0.05).Group C compared with every point after treatment group A calcium has no statistical significance(P > 0.05).Group B and group A all point comparing calcium were significantly lower after treatment was statistically significant(P <.05).Group B and group C each time after treatment ofcalcium,phosphorus and the calcium-phosphorus product,iPTH are significantly reduced,with statistical significance(P < 0.05).Conclusion:1.Pure impact of calcitriol therapy has no obvious advantage in patients with refractory SHPT.Line 2.when the t-PTX treatment of choice for patients with refractory SHPT and effective way.3.Oral quasi calcium treatment for patients with refractory SHPT nonoperative treatment.4.Still need long-term follow-up,to observe the long-term curative effect.