中国血液净化

中国血液净化 ›› 2019, Vol. 18 ›› Issue (02): 104-106.doi: 10.3969/j.issn.1671-4091.2019.02.006

• 临床研究 • 上一篇    下一篇

不同甲状旁腺激素水平对甲状旁腺全切术后患者的临床影响和分析

朱峰1,王琳1,辛明徽1,刘强强1   

  1. 1. 大连大学附属新华医院肾内科
  • 收稿日期:2018-07-26 修回日期:2018-12-09 出版日期:2019-02-12 发布日期:2019-01-25
  • 通讯作者: 朱峰 E-mail:freefeng@163.com
  • 基金资助:

    大连市卫生科研课题1611095

Clinical effect and analysis of different parathyroid hormone level on the patients after total parathyroidectomy

  • Received:2018-07-26 Revised:2018-12-09 Online:2019-02-12 Published:2019-01-25

PDF

605

摘要： 【摘要】目的  通过观察终末期肾病合并继发甲状旁腺功能亢进症患者行甲状旁腺切除术后不同全段甲状旁腺激素(intact parathormone，iPTH)水平与临床心血管事件相关性研究，探讨术后iPTH 合理控制范围。方法  60 例维持性血液透析伴继发甲状旁腺功能亢进行甲状旁腺切除术后患者，分为iPTH＜60pg/ml，iPTH60～150 pg/ml, iPTH150～300pg/ml 3 组，统计相关数据分析。结果   手术治疗后患者Ca、P、钙磷乘积、iPTH、冠状动脉钙化积分较治疗前下降(P 值分别为0.018, 0.034, 0.023, 0.007, 0.006)，术后随着iPTH 逐渐降低，冠状动脉钙化积分逐渐增加，有统计学意义(P 值分别为0.014, 0.026)，iPTH：0～60pg/ml 组患者发生心绞痛、心肌梗死、心律失常、心血管事件死亡均明显高于上述2 组，具有统计学意义(P 值分别为0.023, 0.037, 0.014, 0.046)。结论   慢性肾脏病5 期继发甲状旁腺功能亢进症行甲状旁腺切除术后，冠状动脉钙化明显缓解，同时可有效改善患者高磷情况，但过低iPTH 可导致术后患者心血管事件的发生率明显升高，增加死亡率。

关键词: 继发行甲状旁腺功能亢进症, 甲状旁腺全切术, 冠状动脉钙化, 甲状旁腺激素

Abstract: 【Abstract】Objective To investigate the relationship between different parathyroid hormone level and clinical cardiovascular events in the consecutive dialysis patients with secondary hyperparathyroidism after parathyroidectomy，and to explore the reasonable control range of postoperative iPTH level. Method Sixty patients undergoing maintenance hemodialysis with secondary hyperparathyroidism after parathyroidectomy were divided into three groups: iPTH < 60 pg/ml, iPTH 60-150 pg/ml and iPTH 150-300 pg/ml. Statistical analysis of the relevant data. Result The level of Ca,P,Ca×P,iPTH,CCS of the patients after parathyroidectomy were lower than those before operation (P=0.018, P=0.034, P =0.023, P =0.007, P =0.006). Postoperatively, as the iPTH gradually decreases ,the coronary calcification score gradually increases,the difference had statistical significance (P=0.014, P =0.026). but the cardiovascular events in group iPTH < 60 pg/ml were significantly higher than the above two groups, the difference had statistical significance (P =0.023, P =0.037, P =0.014, P =0.046). Conclusion Coronary artery calcification and hyperphosphatemia can be significantly alleviated after parathyroidectomy in CKD5 patients with secondary hyperparathyroidism. However, too low iPTH can significantly increase the incidence of cardiovascular events and mortality in postoperative patients.

Key words: secondary hyperparathyroidism, parathyroidectomy, coronary artery calcification, parathyroid hormone