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Том 22 №3 2020 год - Нефрология и диализ
Место парикальцитола в профилактике и лечении гиперпаратиреоза у пациентов после трансплантации почки. Обзор литературы
Ветчинникова О.Н.
DOI: 10.28996/2618-9801-2020-3-312-327
Аннотация: Актуальность: гиперпаратиреоз (ГПТ) встречается у трети-половины пациентов с хронической болезнью почек (ХБП), перенесших трансплантацию почки, и оказывает неблагоприятное воздействия на течение просттрансплантационного периода, повышая риск потери почечного трансплантата, возникновения костных переломов, сердечно-сосудистых событий и смертельных исходов. Цель исследования: обзор факторов риска развития ГПТ у пациентов с ХБП после трансплантации почки и эффективности и безопасности применения парикальцитола для его профилактики и лечения. Материалы и методы: обзор литературы проведен с использованием поисковой системы PubMed в электронных базах данных Medline, Embase, Cochrane Library, материалов конференций и поискового портала Международного регистра клинических испытаний по июнь 2020 г. Результаты: существенными факторами риска персистенции и развития de novo ГПТ после трансплантации почки является наличие вторичного ГПТ в дооперационном периоде и снижение функции почечного трансплантата при развитии хронической трансплантационной нефропатии. Парикальцитол продемонстрировал эффективную и безопасную коррекцию вторичного ГПТ в предтраснплантационном периоде - у пациентов с ХБП 3-4 ст. и на этапе диализной терапии, обеспечивая надежное снижение ПТГ крови без значительного изменения сывороточных концентраций кальция и фосфора. Серия небольших наблюдательных исследований и просперктивное рандомизированное открытое исследование Amer Н. et al. из клиники Мэйо (США), выполненные у пациентов после трансплантации почки с ГПТ, показали высокую эффективность парикальцитола в плане подавления избыточной функции околощитовидных желез, синтеза и секреции ПТГ, хорошую переносимость и безопасность в плане развития гиперкальциемии, гиперфосфатемии и функции почечного трансплантата. Заключение: парикальцитол является надежным средством, предупреждающим персистенцию ГПТ у пациентов после трансплантации почки, а также для коррекции вторичного ГПТ у пациентов с функцией почечного трансплантата, соответствующей ХБП 3-4 ст. Необходимы дальнейшие исследования с более длительным сроком наблюдения для оценки спектра дополнительных (плейотропных) эффектов парикальцитола на организм и функцию трансплантированной почки.
Для цитирования: Ветчинникова О.Н. Место парикальцитола в профилактике и лечении гиперпаратиреоза у пациентов после трансплантации почки. Обзор литературы. Нефрология и диализ. 2020. 22(3):312-327. doi: 10.28996/2618-9801-2020-3-312-327
Весь текст
Ключевые слова: гиперпаратиреоз,
хроническая болезнь почек,
трансплантация почки,
парикальцитол,
hyperparathyroidism,
chronic kidney deisease,
kidney transplantation,
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