中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (01): 39-43.doi: 10.3969/j.issn.1671-4091.2017.01.010

• 临床研究 • 上一篇    下一篇

甲状旁腺全切除加前臂自体移植术对继发性甲状旁腺功能亢进症患者左心室肥厚的影响

侯爱珍1,肖观清1,张豫1,陈囿元1,张剑利2,孔耀中1   

  1. 1佛山市第一人民医院(中山大学附属佛山医院)1肾内科,2耳鼻喉科
  • 收稿日期:2016-06-16 修回日期:2016-11-06 出版日期:2017-01-12 发布日期:2017-01-12
  • 通讯作者: 孔耀中 kyzhong@fsyyy.com E-mail:37378508@qq.com

Effect of parathyroidectomy combined with autograft in forearm on left ventricular hypertrophy in uremic patients with secondary hyperparathyroidism

  • Received:2016-06-16 Revised:2016-11-06 Online:2017-01-12 Published:2017-01-12

PDF

516

摘要： 目的观察甲状旁腺全切除加自体前臂移植术(total parathyroidectomy with autotransplantation，tPTX+AT)对尿毒症合并继发性甲状旁腺功能亢进(secondary hyperparathyroidism，SHPT) 患者左心室肥厚的影响。方法选取28 例SHPT 患者，分为手术组(n=13)和非手术组(n=15)，2 组治疗前、后6 月检查血清全段甲状旁腺激素(intact parathyroid hormone ，iPTH)、血清钙(calcium,Ca)、血清磷(phosphorus,P)等水平，心脏超声检查左室舒张末期内径(left ventricular end diastolic
diameter,LVDd)，室间隔厚度(interventricular septal thickness,IVST)、左室后壁厚度(left ventricular posterior wall thickness,LVPWT)、计算左心室质量指数(left ventricular mass index，LVMI)，并记录每例患者心脏瓣膜钙化的瓣膜数，计算每组患者瓣膜钙化率(钙化的瓣膜数/总瓣膜数)等。结果6 月后，术组患者血清iPTH(t=129.592,P＜0.001)、Ca(t=4.318，P=0.049)、血磷(t=16.997,P＜0.001)水平均较术前明显降低,LVMI 由(169.21±51.58)g/m2下降到(118.67±42.52)g/m2,手术治疗对左心室质量指数的影响具有统计学意义(t=8.026,P=0.049)，瓣膜钙化人数术前/术后为9/7人，钙化的瓣膜数术前/术后为12/12 个；非手术组前后6 月血清iPTH 、Ca、P 水平均无显著降低(均P＞0.05)，LVMI 由(161.85±62.43)g/m2升至(208.57±74.61)g/m2，虽无统计学差异(t=0.484,P=0.334),但左心室肥厚有进展趋势，而心脏瓣膜钙化总人数治疗前/后为9/13 人，钙化的总瓣膜数治疗前后为11/21 个，治疗后瓣膜钙化率较治疗前显著升高(46.67%比24.44%，χ2=4.849，P= 0.028)。结论甲状旁腺切除术能有效改善尿毒症SHPT患者的左心室肥厚，而非手术组患者的心脏瓣膜钙化有加重趋势。

关键词: 尿毒症, 继发性甲状旁腺功能亢进, 甲状旁腺切除术, 左心室肥厚, 心脏瓣膜钙化

Abstract: Objective To observe the effect of total parathyroidectomy combined with autologous transplantation in forearm (tPTX+AT) on the left ventricular hypertrophy in uremia patients with secondary hyperparathyroidism (SHPT). Methods A total of 28 SHPT patients were divided into two groups, operation group (n=13) and non-operation group (n=15). Before the operation and after the operation for 6 months, serum calcium (Ca), phosphorus (P), serum parathyroid hormone (iPTH) levels, left ventricular end diastolic diameter (LVED), interventricular septum diastolic thickness (IVST)，left ventricular posterior wall diastolic thickness(LVPWT), left ventricular ejection fraction (LVEF), and left ventricular mass index (LVMl) were measured. The number of calcified valves in each patient was recorded, and the ratio of calcified valves / total valves (%) in each group was calculated. Results After the operation for 6 months in operation group, serum Ca, P and iPTH levels decreased significantly as compared with the pre- operative values (P＜0.001), and LVMI decreased from (169.21±51.58)g/m2 to (118.67± 42.52)g/m2 (t=8.026, P=0.049). The number of patients with valvular calcification decreased from 9 patients to 7 patients, but the number of calcified valves had no change (12 valves). In non-operation group before and after the regular treatment, serum Ca, P and iPTH levels had no significantly changes (P＞0.05), LVMI showed the tendency of deterioration and increased from 161.85± 62.43g/m2 to 208.57±74.61 g/m2 but without statistical significance (t=0.484, P=0.334). The number of patients with valvular calcification increased from 9 patients to 13 patients, the total number of calcified valves increased from 11 valves to 21 valves, and the ratio of calcified valves / total valves increased significantly (46.67% vs. 24.44%, χ2=4.849, P=0.028). Conclusion Parathyroidectomy can effectively improve the left ventricular hypertrophy in uremic patients with SHPT, while patients in non-operation group showed the deterioration of valvular calcification.

Key words: Uremia, Hyperparathyroidism, Parathyroidectomy, left ventricular hypertrophy, cardiac valve calcification