中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (02): 90-92.doi: 10.3969/j.issn.1671-4091.2014.02.007

• 临床研究 • 上一篇    下一篇

甲状旁腺切除对尿毒症继发性甲状旁腺功能亢进症患者营养状态的影响

刘东,李新伦,高卓,缪静,伦立德   

  1. 空军总医院肾内科
  • 收稿日期:2013-10-08 修回日期:2013-11-02 出版日期:2014-02-12 发布日期:2014-02-12
  • 通讯作者: 伦立德 lunlideldm@163.com E-mail:lunlideldm@163.com
  • 基金资助:

    北京首都临床特色应用研究基金(Z111107058811085)资助

Effects of a parathyroidectomy on nutritional status of uremic patients with secondary hyperparathyroidism.

  • Received:2013-10-08 Revised:2013-11-02 Online:2014-02-12 Published:2014-02-12

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摘要： 【摘要】目的 观察甲状旁腺切除对尿毒症继发性甲状旁腺功能亢进症（Secondary Hyperparathyroidism,SHPT）患者营养状态的影响。方法 选取30例尿毒症继发性甲状旁腺功能亢进患者，手术切除甲状旁腺，于手术前及手术1年后使用改良整体主观评估法（modified quantitative subjective global assessment,MQSGA）评估患者营养状况，测量肱三头肌皮褶（TSF）厚度、上臂中部周径（MAC），根据公式计算上臂中部肌肉周径（MAMC）；并比较手术前及手术1年后血清全段甲状旁腺激素（iPTH）、血清磷（P）、钙磷乘积(Ca×P)、血清钙（Ca）、血色素(Hb)、红细胞压积(Hct)、白蛋白(Alb)、转铁蛋白(TF)水平的变化。结果 与手术前比较，手术切除甲状旁腺1年后，患者血iPTH、血磷、钙磷乘积、血钙水平均明显下降（t= -8.78、-4.704、-5.771、-3.990,均P<0.01）；Hb(113.4±14.5 vs 107.2±12.0,P=0.028)、Hct( 0.34±0.05vs0.31±0.04,P=0.017)、Alb(41.2±3.6 vs 39.5±4.0,P=0.016)水平均明显升高，手术前后TF比较差异无统计学意义（P>0.05）；MQSGA评分(8.93±2.12 vs 11.1±4.31,t=-2.652 ,P=0.013)明显下降，TSF(10.23±2.00 vs 9.38±2.06,t=2.257 ,P=0.035)、MAMC(22.3±2.43 vs 21.4±2.63, t=2.536,P= 0.020)明显增加。结论 甲状旁腺切除能有效改善尿毒症继发甲状旁腺功能亢进症患者的营养状态。

关键词: 尿毒症, 继发性甲状旁腺功能亢进, 甲状旁腺切除术, 营养状态

Abstract: 【Abstract】Objective To observe the effect of a parathyroidectomy on nutritional status of uremic patients with secondary hyperparathyroidism. Methods 30 uremic patients with secondary hyperparathyroidism receiced a parathyroidectomy. Before and 1 year after parathyroidectomy, nutritional status of the patients were valuated with modified quantitive subjective global assessment(MQSGA), anthropometric indices including triceps skin fold(TSF) and mid arm circumference(MAC) were measured, mid arm muscle circumference (MAMC) were calculated according to its formula.The patients were prospectively studied the serum parathyroid(iPTH),phosphorus(P),the product of calcium and phosphorus(Ca×P),calcium(Ca),Alb,Hb,Hct, transferrin(TF) before and 1 year after parathyroidectomy. Results Serum levels of iPTH,phosphorus,Ca×P and calcium were lower at 1 year after treatment compared with that before parathyroidectomy (tiPTH=-8.78,P=0.000,tp=-4.704,P=0.000,tca×p=-5.771,P=0.000,tca=-3.990, P=0.001).At 1 year after parathyroidectomy, Hb(113.4±14.5 vs 107.2±12.0,P=0.028)、Hct(0.34±0.05vs0.31±0.04,P=0.017)、Alb(41.2±3.6 vs39.5±4.0, P=0.016)were increased. MQSGA score were lower (8.93±2.12 vs 11.1±4.31,t=-2.652,P=0.013),TSF(10.23±2.00vs9.38±2.06,t=2.257,P= 0.035)，MAMC(22.3±2.43vs21.4±2.63, t=2.536, P=0.020) were improved. Conclusion Parathyroidectomy could improve nutritional status of uremic patients with secondary hyperparathyroidism.

Key words: Uremia, Secondary hyperparathyroidism, Parathyroidectomy, nutrition