中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (07): 469-473.doi: 10.3969/j.issn.1671-4091.2017.07.009

• 临床研究 • 上一篇    下一篇

甲状旁腺切除前后维持性血液透析患者的血压和血钙变化及其相关分析

林新伟1,杨宇1,赵茹1   

  1. 解放军第152中心医院
  • 收稿日期:2016-11-28 修回日期:2017-05-02 出版日期:2017-07-12 发布日期:2017-07-14
  • 通讯作者: 杨宇 840577492@qq.com E-mail:840577492@qq.com

Correlation analyses of blood pressure and calcium changes in maintenance hemodialysis patients after parathyroidectomy

  • Received:2016-11-28 Revised:2017-05-02 Online:2017-07-12 Published:2017-07-14

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摘要： 目的评估甲状旁腺切除术(parathyroidectomy，PTx)对血液透析(hemodialysis，HD)患者血压的影响，了解手术前后血钙与血压变化的相关性，比较手术前后HD 中间低血压的发生率。方法2009 年1 月至2016 年12 月接受PTx 的31 例患有继发性甲状旁腺功能亢进(secondary hyperparathyroidism，SHPT)的维持性HD 患者为研究对象。动态观察PTx 前后实验室检测数据、血压的变化。比较PTx 前后低血压的发生率。分析PTx 前后血压差值与血钙差值的相关性。结果术后第1、2、4 及8 周的收缩压(systolic blood pressure，SBP)较术前1 周[(156.81±28.27)mmHg]明显下降，并呈递减趋势，呈显著的统计学差异(分别为：LSD-t=5.992, P< 0.001; LSD-t=6.621,P＜0.001；LSD-t=7.318,P＜0.001；LSD-t=9.210,P＜0.001)。术后第8 周[(117.37±12.16)mmHg]与术后第1 周[(130.38±15.56)mmHg]相比，SBP 降至最低，两者有显著统计学差异(LSD-t=3.268,P=0.002)。舒张压(diastolic blood pressure，DBP)术后第4、8 周与术前第1 周相比则有显著的统计学意义的下降(分别为：LSD-t=4.046，P=0.002；LSD-t=6.421，P＜0.001)；术后第8 周[(67.52±8.38)mmHg]与术后第1 周[(79.83±11.17)mmHg]相比，DBP 降至最低，两者有显著统计学差异(LSD-t=4.678，P＜0.001)。在手术前后6 周期间内，各有558例次HD, 低血压发生率分别为1.8(% ) 和8.6(% )，两者发生率有显著统计学差异(χ2=26.260,P＜0.001)。手术前后血钙差值与SBP 的差值呈正相关(r=0.630,P=0.006)。手术前后血钙下降的程度与DBP 的变化虽有一致性，但无统计学意义(r=0.331,P=0.070)。结论PTx 不仅可以有效控制维持性血透患者的SHPT，显著降低全段甲状旁腺素(intact parathyroid hormone，iPTH)、血钙、血磷水平，而且术后血压下降明显，尤其SBP 下降较DBP 下降更明显。SBP 下降的幅度与血钙下降的幅度呈显著的相关性。但是，PTx 术后HD 中间低血压的发生率则有明显增加。

关键词: 甲状旁腺切除术, 血压, 血液透析, 血钙

Abstract: Objective To evaluate the effect of parathyroidectomy (PTX) on blood pressure in maintenance hemodialysis (MHD) patients, to understand the correlation between serum calcium and blood pressure, and to compare the incidence of intradialytic hypotension before and after PTX. Methods A total of 31 MHD patients treated with PTX due to secondary hyperparathyroidism (SHPT) were enrolled in this study. Laboratory parameters, predialytic and intradialytic blood pressure, and the incidence of intradialytic hypotension were compared before and after PTX. The correlation between blood pressure difference and serum calcium difference before and after PTX was analyzed. Results Systolic blood pressure (SBP) after PTX for 1, 2, 4 and 8 weeks was significantly lower than that before operation in a week (156.81±28.27 mmHg; LSD-t=5.992, P<0.001 after PTX for one week; LSD-t=6.621, P<0.001 after PTX for 2 weeks; LSD-t=7.318, P<0.001 after PTX for 4 weeks; LSD-t=9.210, P<0.001 after PTX for 8 weeks). SBP decreased gradually after PTX and to the nadir after PTX for 8 weeks (117.37±12.16 mmHg). There was significant difference in SBP after PTX for one week (130.38±16.65 mmHg) and that after PTX for 8 weeks (LSD-t=3.268, P=0.002). Diastolic blood pressure (DBP) after PTX for 4 and 8 weeks was significantly lower than that after PTX for one week (LSD-t=4.046, P=0.002 after PTX for 4 weeks; LSD-t=6.421, P<0.001 after PTX for 8 weeks). DBP decreased to the nadir after PTX for 8th weeks (67.52±8.38 mmHg). There was significant difference in DBP after PTX for one week (79.83±11.17 mmHg) and that after PTX for 8 weeks (LSD-t=4.678, P＜0.001). The in-cidence of hypotension was 1.8% in the 558 hemodialysis sessions in the 6 weeks before PTX, and the incidence was 8.6% in the 558 hemodialysis sessions in the 6 weeks after PTX (χ2=26.260, P<0.001). The change of serum calcium was positively correlated with the change of SBP before and after PTX (r=0.630, P=0.006). The change of serum calcium was also positively correlated with the change of DBP but without statistical significance (r=0.331, P=0.070). Conclusion PTX effectively ameliorates SHPT with the decrease of iPTH, serum calcium, serum phosphorus, and blood pressure in MHD patients. SBP decreased more than DBP after PTX. The decrease of SBP was positively correlated with the decrease of serum calcium. However, the incidence of intradialytic hypotension increased after PTX.

Key words: Parathyroidectomy, Blood pressure, Hemodialysis, serum calcium