中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (03): 168-171.doi: 10.3969/j.issn.1671-4091.2016.03.011

• 临床研究 • 上一篇    下一篇

甲状旁腺切除对维持性血液透析患者肾性贫血的影响

张敬丽1,封素娟1,李寒1,王世相1   

  1. 首都医科大学附属北京朝阳医院血液净化科
  • 收稿日期:2016-01-14 修回日期:2016-01-21 出版日期:2016-03-12 发布日期:2016-03-19
  • 通讯作者: 李寒 hanli@ccmu.edu.cn E-mail:hanli@ccmu.edu.cn
  • 基金资助:

    北京市卫生系统高层次卫生技术人才培养项目(2013-3-016)

Effect of parathyroidectomy on renal anemia in maintenance hemodialysis patients

  • Received:2016-01-14 Revised:2016-01-21 Online:2016-03-12 Published:2016-03-19

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摘要： 目的探讨甲状旁腺切除对维持性血液透析患者肾性贫血的影响。方法回顾性分析25例因继发性甲状旁腺功能亢进而行甲状腺切除术的维持性血液透析患者术后血清钙，磷及全段甲状旁腺激素(intact parathyroid hormone, iPTH)等的变化，分析术后1 月，3 月和6 月血红蛋白及红细胞生成素用量变化情况。结果①与术前相比[(1825.44±936.92)pg/L]，患者术后1 月[(156.25±149.80)pg/L]，3 月[(104.53±131.21)pg/L]和6 月[(110.01±143.85)pg/L]iPTH 水平均显著下降[1 月：t=7.994，P=0.000；3 月：t=8.430,P=0.000;6 月t=8.289,P=0.000]，差异具有统计学意义；与术前相比[(2.29 ± 0.41)mmol/L]，患者术后1 月[(1.57 ± 0.59)mmol/L]，3 月[(1.73 ± 0.64)mmol/L] 和6 月[(1.46±0.46)mmol/L]血磷水平均显著下降[1 月：t=5.341，P=0.000；3 月：t=4.050,P=0.000；6 月t=7.749,P=0.000]，差异具有统计学意义。②与术前相比，患者术后1 个月、3 个月、6 个月血红蛋白(hemoglobin,Hb)水平差异无统计学意义(P＞0.05)；但与术前相比，术后EPO 用量逐渐减少，术后3 个月、6 个月差异具有统计学意义[3 个月：(149.77±35.98)IU/(kg•周)比(226.18±65.47)IU/(kg•周)，t=4.672，P=0.000；6 个月：(121.53±26.50)IU/(kg•周)比(226.18±65.47)IU/(kg•周),t=6.606，P=0.000]。③红细胞生成素用量与患者iPTH 水平呈正相关(r=0.48, P=0.00)有统计学差异。结论甲状腺切除能明显改善维持性血液透析患者肾性贫血，减少红细胞生成素用量。

关键词: 甲状旁腺切除, 肾性贫血, 维持性血液透析, 红细胞生成素

Abstract: Objective To investigate the effect of parathyroidectomy (PTX) on the progression of renal anemia in maintenance hemodialysis (MHD) patients. Methods A total of 25 MHD patients with secondary hyperparathyroidism treated with PTX in the recent 7 years were retrospectively analyzed. The changes of serum intact parathyroid hormone (iPTH), calcium (Ca) and phosphorus (P) after PTX were evaluated. The supplement doses of recombinant human erythropoietin (EPO) were recorded. Results Serum iPTH, Ca, and P levels were significantly decreased after PTX. No significant difference of hemoglobin level was found after the operation for 1, 3 and 6 months, but the dose of EPO decreased after the operation. There was a positive correlation between the dose of EPO and the level of serum iPTH in MHD patients (r=0.48, P=0.00). Conclusion PTX can significantly reduce the dose of EPO and delay the progression of renal anemia in MHD patients with renal anemia.

Key words: Parathyroidectomy, Renal anemia, Maintenance hemodialysis, Erythropoietin