中国血液净化

中国血液净化 ›› 2012, Vol. 11 ›› Issue (04): 194-197.doi: 10.3969/j.issn.1671-4091.2012.04.00

• 临床研究 • 上一篇    下一篇

尿毒症不同程度异位钙化患者行甲状旁腺切除手术的疗效比较研究

曹红娣 汤 兵 宋宗纬 赵庆洪 侯大卫 张 桦 闻 萍 叶 红 张 平 杨俊伟   

  1. 南京医科大学第二附属医院
  • 收稿日期:2011-11-02 修回日期:1900-01-01 出版日期:2012-04-12 发布日期:2012-04-12
  • 通讯作者: 杨俊伟

Clinical observation of parathyroidectomy in uremic patients with different degrees of ectopic calcification

CAO Hong-di, TANG Bing, SONG Zong-wei, ZHAO Qing-hong, HOU Da-wei, ZHANG Hua, WEN Ping, YE Hong, ZHANG Ping, YANG Jun-wei   

  • Received:2011-11-02 Revised:1900-01-01 Online:2012-04-12 Published:2012-04-12

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摘要： 【摘要】 目的 比较在尿毒症继发性甲状旁腺机能亢进不同程度异位钙化患者中行甲状旁腺切除术的近期及远期疗效。方法术前依据有无心血管系统异位钙化将患者分为2组：影像学无明确异位钙化的A组和影像学提示有明确异位钙化的B组。观察2组患者术前术后症状、全段甲状旁腺激素(intact parathyroid hormone，iPTH)、补钙方案、心血管事件发生率等指标的异同。结果42例患者行甲状旁腺切除术，A组17例，B组25例，术后随访20±6月。A组术后症状消失，随访期间症状无反复，术后血钙平稳，无不良心血管事件发生，无新发心血管系统钙化。B组术后症状改善，6例患者症状出现反复，血钙水平较低，静脉补钙时间较长，术后2例患者因心脑血管事件死亡。结论 心血管系统异位钙化程度较轻的继发性甲状旁腺机能亢进患者行甲状旁腺切除术，术后症状改善持续，血钙平稳，可延缓心血管系统钙化进展。

关键词: 继发性甲状旁腺机能亢进, 甲状旁腺切除术, 异位钙化

Abstract: 【Abstract】Objective To analyze the therapeutic effects of parathyroidectomy (PTX) in uremic patients with secondary hyperparathyroidism (SHPT) and different degrees of ectopic calcification. Methods Patients were divided into two groups: group A without specific image of cardiovascular ectopic calcification, and group B with apparent cardiovascular ectopic calcification on X ray and/or ultrasound examinations. Pre- and post-operation symptoms and signs, iPTH, calcium supplementation protocol, cardiovascular events, as well as other indications were observed.  Results Among the 42 SHPT patients that underwent PTX, 17 were enrolled in group A, and 25 patients in group B. In group A after the operation, pruritus and bone pain symptoms were largely relieved, with stable serum calcium level and without the development of adverse cardiovascular events or cardiovascular calcification; in group B, however, the symptoms relieved also after the operation but recurred in 6 patients, and serum calcium levels were lower than those in group A. Seven patients in group A needed to have intravenous calcium administration for more than 6 months. Two patients died of cardiovascular or cerebrovascular events.  Conclusions The prognosis of SHPT patients after PTX is negatively correlated with the severity of vascular ectopic calcification. PTX may help delay the progress of cardiovascular calcification.

Key words: Secondary hyperparathyroidism, Parathyroidectomy, Ectopic calcification