目的 探讨碳酸镧联合西那卡塞、骨化三醇对维持性血液透析伴继发性甲状旁腺功能亢进 症（secondary hyperparathyroidism，SHPT）患者甲状腺激素、磷钙代谢及临床症状的影响。方法 回顾性分 析本院门诊 2017 年 1 月至 2020 年 4 月 90 例维持性血液透析伴 SHPT 患者临床资料，依照给药方式，将采用 单纯骨化三醇治疗的患者 16 例纳入 C 组，采用西那卡塞联合骨化三醇治疗的患者 36 例纳入 B 组，采用碳 酸镧联合骨化三醇、西那卡塞治疗的患者 38 例纳入 A 组，比较三组患者临床症状、血清全段甲状旁腺激素 （iPHT）水平、磷钙代谢水平、不良反应发生情况。结果 A 组治疗后 1、3、6 个月血清 iPHT 水平低于 B 组， B 组低于 C 组（P＜0.05）；A 组、B 组治疗后 6 个月 iPTH 达标率分别为 94.74%、83.33%，高于 C 组 56.25% （P＜0.05）；三组患者治疗后皮肤瘙痒、骨关节疼痛症状均较治疗前改善（P＜0.05）；三组患者治疗后皮肤 瘙痒、骨关节疼痛比例比较差异无统计学意义（P＞0.05）；A组、B组治疗后1、3、6个月血钙、血磷、钙磷乘积 低于 C 组，A 组血磷、钙磷乘积低于 B 组（P＜0.05）；三组患者治疗期间不良反应发生率比较（P＞0.05）。 结论 碳酸镧联合西那卡塞、骨化三醇可有效改善维持性血液透析伴 SHPT 患者临床症状，降低 iPHT 激 素水平，改善钙磷代谢，用药安全性较高。

Objective To explore the effects of lanthanum carbonate combined with cinacalcet and calcitriol on thyroid hormone ，phosphorus ⁃ calcium metabolism and clinical symptoms in hyperparathyroidism patients undergoing maintenance hemodialysis（MHD）. Methods The clinical data of 90 patients with secondary hyperparathyroidism（SHPT）who underwent MHD in outpatient of the hospital from January 2017 to April 2020 were retrospectively analyzed. According to different administration methods，the 16 patients who were treated with calcitriol were included in group C，36 patients who treated with cinacalcet and calcitriol were included in group B，and 38 patients who treated with lanthanum carbonate combined with calcitriol and cinacalcet were included in group A. The clinical symptoms，levels of serum intact parathyroid hormone（iPHT）and phosphorus ⁃calcium metabolism，and occurrence of adverse reactions were compared among the three groups. Results At 1 month，3 months and 6 months after treatment，level of serum iPHT was the highest in group C，followed by group B and group A（P < 0.05）. At 6 months after treatment，controls rates of iPTH in groups A and B were 94.74% and 83.33%，which were higher than that in group C（56.25%）（P < 0.05）. After treatment，skin itching and bone joint pain in the three groups were improved（P < 0.05）. There was no significant difference in the proportion of patients with skin itching and bone joint pain among the three groups（P > 0.05）. At 1 month，3 months and 6 months after treatment，serum calcium，serum phosphorus and calcium phosphorus product in group A and B were lower than those in group C. The serum phosphorus and calcium phosphorus product in group A were lower than those in group B（P < 0.05）. There was no significant difference in the incidence of adverse reactions during treat⁃ ment among the three groups（P > 0.05）. Conclusion Lanthanum carbonate combined with cinacalcet and cal⁃citriol can effectively improve clinical symptoms of SHPT patients undergoing MHD，reduce iPHT level，and im⁃ prove calcium⁃phosphorus metabolism，with relatively higher medication safety.