ЗНАЧИМОСТЬ ЦИНАКАЛЬЦЕТА В КОРРЕКЦИИ НАРУШЕНИЙ ФОСФОРНО-КАЛЬЦИЕВОГО БАЛАНСА У БОЛЬНЫХ С ХРОНИЧЕСКОЙ БОЛЕЗНЬЮ ПОЧЕК

Вторичный гиперпаратиреоз (ВГПТ) является частым проявлением хронической болезни почек (ХБП) и приводит не только к остеодистрофии, увеличивающей риск переломов, но и к внекостным проявлениям, включающим сосудистую кальцификацию, гипертензию, анемию, кожный зуд и сексуальные расстройства. Эпидемиологические данные указывают на связь высоких значений паратгормона (ПТГ), кальция (Са) и фосфата (Р) крови с повышенной смертностью пациентов. Традиционная терапия ВГПТ у пациентов на заместительной почечной терапии витамином D и фосфат-связывающими препаратами подавляет секрецию паратгормона (ПТГ), но при этом вызывает гиперкальциемию и гиперфосфатемию, способствующих развитию эктопической кальцификации и повышению летальности. Поэтому в 2004 г. в клиническую практику для коррекции ВГПТ был введен новый класс препаратов – кальцимиметиков (КМ), единственным представителем которых на сегодняшний день является цинакальцет (ЦК)(Mimpara, Sensipar). ЦК повышает порог реагирования кальций-чувствительных рецепторов паращитовидных желез на кальций крови – наиболее сильный ингибитор секреции ПТГ, что приводит к снижению уровня в крови этого гормона, уменьшению резорбции Са и Р из костей и падению их концентраций в крови. В ряде исследований было показано, что КМ способны вызывать регрессию гиперплазии ПЩЖ, снижая риск выполнения паратиреоидэктомии. Получены доказательства, что ЦК уменьшает тяжесть уремической остеодистрофии и частоты переломов. Благодаря снижению уровней ПТГ, Са и Р крови, а также прямому действию на сосуды ЦК тормозит развитие сосудистого кальциноза. В экспериментальных исследованиях показано, что ЦК уменьшает выраженности артериальной гипертензии, вероятно, вследствие прямого вазодилатирующего эффекта, а также подавления секреции ренина. В конечном итоге применение ЦК снижает частоту госпитализаций по поводу кардиоваскулярной патологии. В настоящее время проводится исследование влияния терапии ЦК на выживаемость пациентов. Препарат надежно контролирует ВГПТ у пациентов после трансплантации почки и позволяет избежать выполнения паратиреоидэктомии. В опытах на животных с применением кальцимиметиков получены данные об эффективном снижении выраженности протеинурии и замедлении прогрессирования снижения скорости клубочковой фильтрации, что обосновывает применение ЦК на ранних стадиях ХБП, но эти данные требуют клинического подтверждения. Увеличивается доказательная база эффективности комбинации ЦК и малых доз ВД у пациентов на заместительной почечной терапии (принимая во внимание позитивные кардио- и нефропротективные эффекты последнего).

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