中国血液净化

中国血液净化 ›› 2019, Vol. 18 ›› Issue (01): 1-7.doi: 10.3969/j.issn.1671-4091.2019.01.001

• 临床研究 •    下一篇

甲状旁腺切除术后维持性血液透析患者腹主动脉钙化及骨代谢指标改变

师红红1,2,张翠芳3,吕程3,周加军4,张凌2,王利华5   

  1. 1山西医科大学第二临床医学院
    2中日友好医院肾内科
    3北京市朝阳区孙河社区卫生服务中心
    4皖南医学院附属第一医院血液净化中心
    5山西医科大学第二医院肾内科山西省肾脏病研究所
  • 收稿日期:2018-07-06 修回日期:2018-10-24 出版日期:2019-01-12 发布日期:2018-12-25
  • 通讯作者: 张凌 zhangling5@medmail.com.cn 王利华 lihuawang236@126.com E-mail:zhangling5@medmail.com.cn
  • 基金资助:

    首都临床特色应用研究与成果推广(Z151100004015112)

Changes of abdominal aortic calcification and bone metabolism after parathyroidectomy in maintenance hemodialysis patients

  • Received:2018-07-06 Revised:2018-10-24 Online:2019-01-12 Published:2018-12-25

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摘要： 【摘要】目的观察维持性血液透析(maintenance hemodialysis,MHD)患者甲状旁腺切除术(parathyroidectomy，PTX)后腹主动脉钙化及骨代谢指标的改变并对相关因素进行分析。方法回顾性分析12 例PTX 后完成1 年随访的MHD 患者，满足PTX 后1 周血全段甲状旁腺素(intact parathyroid hormone，iPTH)≤600pg/ml，随访期间继发性甲状旁腺功能亢进未复发。收集患者的基线资料及术前、术后6、术后12 月的腹主动脉钙化评分(abdominal aortic calcification score,AACS)、血清钙、血清磷、血清碱性磷酸酶、iPTH 及血清骨代谢指标。结果12 例MHD 患者年龄(51.33±13.28)岁，透析龄(138.58±57.61)月，男性(4/12，33.3%)，女性(8/12，66.7%)。比较术前、术后6 月、术后12 月之间AACS 无显著差异(χ2=1.529，P =0.465)。术后充足补钙的结果是血清钙在术后6 月较术前无显著差异(P=0.307)，术后12 月较术前明显降低(P=0.003)。血清磷在术后6 月、12 月较术前明显降低(P 值均为0.043)。ALP 在术后12 月较术前明显降低(P=0.003)。iPTH 在术后6 月、12 月较术前明显降低(P 值分别为＜0.001，0.003)。血清学骨代谢标志物与术前相比，TRACP、CTX、BAP 在术后6 月明显下降(P 值分别为0.013，＜0.001，0.002)，在术后12 月亦明显下降(P 值分别为＜0.001，0.001，＜0.001)。P1NP、N-MID-OC 在术后6 月较术前下降，但无统计学差异(P 值分别为0.124，0.307)，在术后12 月较术前明显下降(P 值分别为＜0.001，0.003)。结论小样本资料显示PTX 可纠正钙、磷、ALP 代谢紊乱，改善紊乱的血清骨代谢指标，减慢骨转运速度，阻止腹主动脉钙化进展，但对已发生的腹主动脉钙化可能无减轻作用。

关键词: 甲状旁腺切除术, 维持性血液透析, 腹主动脉钙化评分, 骨代谢指标

Abstract: 【Abstract】Objective To investigate the changes of cardiovascular calcification and bone metabolism and their related factors after parathyroidectomy (PTX) in maintenance hemodialysis (MHD) patients. Methods Twelve MHD patients undergoing PTX operation and follow-up for one year were retrospectively analyzed. Intact parathyroid hormone (iPTH) of these patients was <600pg/ml after PTX for one week, and recurrence of secondary hyperparathyroidism was not found during the follow-up period. Baseline information, abdominal aortic calcification score (AACS), and serum calcium, phosphate, serum alkaline phosphatase (ALP), iPTH and bone metabolism markers were recruited before PTX and after PTX for 6 and 12 months. Results A total of 12 MHD patients after PTX (4 males and 8 females, 51.33 ±13.28 years of age, and 138.58±57.61 months of dialysis vintage) were enrolled in this study. There was no significant difference in AACS between baseline and after PTX for 6 and 12 months (χ2=1.529，P=0.465). Adequate calcium supplement after PTX resulted
in no significant difference in serum calcium between baseline and after PTX for 6 months. However, serum calcium was significantly lower after PTX for 12 months as compared to that of baseline (P=0.003). Serum phosphate levels after PTX for 6 and 12 months were significantly lower than the baseline value (P=0.043). ALP after PTX for 12 months was significantly lower than that of baseline (P=0.003). iPTH levels after PTX for 6 and 12 months were also significantly lower than the baseline value (P＜0.001 and P=0.003 respectively). For serum bone metabolism markers, TRACP, CTX and BAP decreased significantly after PTX for 6 months (P=0.013, P＜0.001 and P=0.002 respectively) and 12 months (P＜0.001, P=0.001 and P＜0.001 respectively); P1NP and N-MID-OC after PTX for 6 months were lower than those of baseline but without statistical significance (P=0.124 and 0.307 respectively). P1NP and N-MID-OC after PTX for 12 months were significantly lower those of baseline (P＜0.001 and P=0.003 respectively). Conclusion PTX can improve the disorders of calcium, phosphate and ALP as well as bone metabolism, decrease the rate of bone metabolism turnover, and prevent the progression of cardiovascular calcification. However, PTX may not ameliorate the existed cardiovascular calcification.

Key words: Parathyroidectomy, Maintenance hemodialysis, Abdominal aortic calcification, Bone metabolism markers