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盐酸西那卡塞可降低原发性顽固性甲状旁腺功能亢进症患者的血清钙浓度

Cinacalcet Reduces Serum Calcium Concentrations in Patients with Intractable Primary Hyperparathyroidism

Marcocci C, Chanson P, Shoback D 2010/4/28 18:09:16

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J Clin Endocrinol Metab, 2009,

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Context:
Patients with persistent primary hyperparathyroidism (PHPT) after parathyroidectomy or with contraindications to parathyroidectomy often require chronic treatment for hypercalcemia.

Objective:
The objective of the study was to assess the ability of the calcimimetic, cinacalcet, to reduce serum calcium in patients with intractable PHPT.

Design:
This was an open-label, single-arm study comprising a titration phase of variable duration (2–16wk) and a maintenance phase of up to 136wk.

Setting:
The study was conducted at 23 centers in Europe, the United States, and Canada.

Patients:
The study included 17 patients with intractable PHPT and serum calcium greater than 12.5mg/dl (3.1mmol/liter).

Intervention:
During the titration phase, cinacalcet dosages were titrated every 2wk (30mg twice daily to 90mg four times daily) for 16wk until serum calcium was 10mg/dl or less (2.5mmol/liter). If serum calcium increased during the maintenance phase, additional increases in the cinacalcet dose were permitted.

Main Outcome Measure:
The primary end point was the proportion of patients experiencing a reduction in serum calcium of 1mg/dl or greater (0.25mmol/liter) at the end of the titration phase.

Results:
Mean±sd baseline serum calcium was 12.7±0.8mg/dl (3.2±0.2mmol/liter). At the end of titration, a 1mg/dl or greater reduction in serum calcium was achieved in 15 patients (88%). Fifteen patients (88%) experienced treatment-related adverse events, none of which were serious. The most common adverse events were nausea, vomiting, and paresthesias.

Conclusions:
In patients with intractable PHPT, cinacalcet reduces serum calcium, is generally well tolerated, and has the potential to fulfill an unmet medical need.

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疾病资源中心

高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

甲状腺功能亢进合并黄疸

王燕燕王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。

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