在上一篇,我們回顧了“為什麼洗腎患者會副甲狀腺機能亢進”,在結語中有提到,那是因為:
1. 磷離子上升,會刺激它。
2. 鈣離子下降,會刺激它。
3. 活性維他命D減少,無法壓制它。
4. FGF-23上升。
都記起來了嗎?太好了!那麼,怎麼治療副甲狀腺機能亢進,就不難理解了嘛,只要把那幾個原因消滅掉,副甲狀腺自然能夠得到控制!讓我們一個一個來:
1. 控制血中磷離子濃度–怎麼做?請看降磷系列文1、2、3、4。
2. 使用鈣片、或高鈣透析–但是兩者都有隱憂,請見文章1、2。
3. 補充維他命D—原料的與活性的維他命D都很重要,請見連結文章。
4. 目前沒有藥物。
深入分析我們有的選項,其中,使用鈣片那個選項,由之前的文章知道,其實有很大的隱憂。用鈣片來降磷,還能夠順便抑制副甲狀腺,看起來這個選擇十分合理。只可惜,使用鈣片可能會使得身體吸收太多的鈣,時間久了可能會導致高血鈣、或者體內血管鈣化變硬的情況,這些都是我們不希望看到的結果。
還記得副甲狀腺裡有鈣的偵測器嗎?聰明的人類發明了一種藥物,可以改變這些偵測器,讓偵測器變得比以前靈敏,會以為鈣真的變多了,但其實鈣的濃度沒有變,變的是偵測器的靈敏度,因此不會在體內形成鈣化那些問題,我們稱這種藥物為“擬鈣劑”。
還是不大懂嗎?可以想想助聽器的例子,人隨著年紀越來越大,耳朵越來越背,也就是對聲音的反應會越來越不靈敏,旁人就算把聲音加大,還不一定能讓耳背的人聽到呢。而讓這些人戴上助聽器之後,正常音量也能聽到了,對於戴上助聽器的人來說,他還以為是旁邊的人說話變大聲了呢,實際上,旁人的音量是一樣的。
擬鈣劑,就是鈣離子偵測器的助聽器,讓它以為鈣變多了(聲音變大了),進而抑制副甲狀腺。
2004年,擬鈣劑 Cinacalcet的使用正式獲得許可,至今使用上的經驗以及研究都十分廣泛。在台灣,是日本Kirin公司進口的Regpara,中文名稱為:銳克鈣。
開始使用擬鈣劑治療之後,副甲狀腺素的分泌減少,會產生甚麼反應呢?還記得我們在講副甲狀腺的功能時,副甲狀腺素的效果是什麼呢?
一、叫骨頭把儲藏在骨頭中的鈣放出來,跑到血液中,而使得血中鈣離子濃度增加,另外,這個動作會連帶把骨頭中的磷一起放出來。
二、叫腎臟把鈣離子從尿中回收回來,減少鈣離子從尿中流失掉。
三、叫腎臟多製造一點活性維他命D,讓活性維他命D去督促腸子多吸收一點鈣,進而讓身體鈣總量增加。
咦?為什麼把第二點和第三點劃掉?
因為腎臟沒有功能了啊,所以副甲狀腺就只會影響骨頭囉,當副甲狀腺素分泌減少,骨頭就開始回收鈣和磷,因此,鈣與磷兩個手牽手,一起進到骨頭裡,血中的鈣離子減少了,磷離子多半也會跟著減少。
要怎麼知道吃了擬鈣劑之後,有沒有效果?文獻中提到,血中鈣離子多半在12-24小時之後,就會開始減少,而如果抽血有看到血鈣下降,幾乎就是表示副甲狀腺已經受到抑制。當血鈣與血磷都一起下降的時候,我們常常會合併使用活性維他命D,來治療副甲狀腺亢進,因為活性維他命D會增加腸道吸收鈣和磷,血鈣與血磷會上升,這麼一來,能夠抵銷擬鈣劑降低鈣與磷的效果,又能進一步抑制副甲狀腺,達到“摸蜆仔兼洗褲”的效果。
使用擬鈣劑,除了治療副甲狀腺的療效之外,更深層的意義是:它會使得血中的鈣回到骨頭裡,這一點非常重要,因為血管裡面的鈣減少了,就會減少血管鈣化的危險,當維他命D併用擬鈣劑的治療,和單獨使用維他命D相比較的話,有併用擬鈣劑的患者,大動脈、冠狀動脈的鈣化速度大幅下降。
使用擬鈣劑治療的洗腎患者,血管鈣化程度較輕,所以,因心血管疾病而住院的患者變少了,須接受進一步的副甲狀腺切除的患者減少了,骨折的發生也減少了,看起來一切是這麼的美好。
在EVOLVE研究中(Evaluation of Cinacalcet HCl Therapy to Lower Cardiovascular Events),65歲以上的長者受惠於擬鈣劑更為明顯,總死亡率在這個年長的族群可以看到減少,至於為何65歲以下的患者看不到總死亡率下降,我覺得只是因為實驗的時間不夠長,而看不出更長期的效果,另外,由於藥物副作用(嘔吐或噁心感)的關係,導致受試者不一定有規則服藥,而影響了結果等等。
未來,還有新的擬鈣劑還在研發當中,有一種藥物是一周三次靜脈注射,代號為 AMG 416,這個是直接刺激鈣離子感受器的藥物,希望它能有更好的表現、更少的副作用、以及更少的花費。
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22date%22%3A%22May%207%2C%202015%22%2C%22language%22%3A%22eng%22%2C%22DOI%22%3A%2210.2215%5C%2FCJN.10221014%22%2C%22ISSN%22%3A%221555-905X%22%2C%22url%22%3A%22%22%2C%22collections%22%3A%5B%5D%2C%22dateModified%22%3A%222015-07-10T13%3A36%3A18Z%22%7D%7D%5D%7D 1.
Rodríguez M, Goodman WG, Liakopoulos V, Messa P, Wiecek A, Cunningham J. The Use of Calcimimetics for the Treatment of Secondary Hyperparathyroidism: A 10 Year Evidence Review.
Semin Dial. Published online March 8, 2015.
http://doi.org/10.1111/sdi.12357 1.
Moe SM, Abdalla S, Chertow GM, et al. Effects of Cinacalcet on Fracture Events in Patients Receiving Hemodialysis: The EVOLVE Trial.
J Am Soc Nephrol. 2015;26(6):1466-1475.
http://doi.org/10.1681/ASN.2014040414 1.
Floege J, Kubo Y, Floege A, Chertow GM, Parfrey PS. The Effect of Cinacalcet on Calcific Uremic Arteriolopathy Events in Patients Receiving Hemodialysis: The EVOLVE Trial.
Clin J Am Soc Nephrol. 2015;10(5):800-807.
http://doi.org/10.2215/CJN.10221014