中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (09): 643-646.doi: 10.3969/j.issn.1671-4091.2014.09.009

• 临床研究 • 上一篇    下一篇

甲状旁腺全切除术有效改善16例退缩人综合征临床分析

王琳1,刘强强1,李峻岭1,付瑶2,白璐1,张凌3,张军1,朱峰1,陈东1,姚力3   

  1. 1. 大连大学附属新华医院
    2. 大连市中心医院
    3. 卫生部中日友好医院肾内科
  • 收稿日期:2014-03-18 修回日期:2014-08-14 出版日期:2014-09-12 发布日期:2014-09-02
  • 通讯作者: 姚力 zhongriyaoli@163.com E-mail:zhongriyaoli@163.com

Effect of total parathyroidectomy on shrinking man syndrome : Clinical analysis of 16 cases

  • Received:2014-03-18 Revised:2014-08-14 Online:2014-09-12 Published:2014-09-02

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摘要： 目的 分析甲状旁腺全切除术对维持性血液透析患者并发退缩人综合征的临床疗效。方法选择维持性血液透析合并退缩人综合征患者16 例，收集患者术前及术后的一般资料、临床症状、身高变化和全段甲状旁腺激素(intact parathyroid hormone,iPTH)、血钙、血磷及钙磷乘积。 结果 患者术后3 个月体质量增长2～10kg，身高无明显变化，已形成的骨畸形有所改善, 所有患者在术后1 天内骨痛及皮肤瘙痒症状很快缓解。患者血清iPTH 在术后1 周较术前明显下降，第1 和3 个月长期维持在较低水平(20.4 ± 13.5pg/ml，36.3 ± 17.4pg/ml，41.7 ± 23.9 pg/ml 比4120.7 ± 865.4pg/ml，F 值分别为359.10，356.26,355.19.P＜0.01)；与术前相比，血清钙在术后1 周内迅速下降；第1 和3 个月后逐渐升高，但明显低于术前水平(2.02±0.19mmol/L，2.28±0.37 mmol/L，2.20±0.21 mmol/L 比2.71±0.22mmol/L，F 值分别为90.15，15.97,44.99.P＜0.01)；与术前相比，血清磷水平术后1 周也呈快速显著降低，第1 和3 个月长期维持在正常水平(1.05±0.21mmol/L，1.08± 0.24 mmol/L，1.25±0.31mmol/L 比2.39±0.29mmol/L，F值分别为224.10，193.77,115.79.P＜0.01)。 结论 甲状旁腺全切术是治疗维持性血液透析并发退缩人综合征的一种安全有效的手段。

关键词: 退缩人综合征, 继发性甲状旁腺功能亢进, 甲状旁腺全切术

Abstract: Abstract Objective To investigate the effect of total parathyroidectomy on patients with shrinking man syndrome undergoing maintenance hemodialysis. Methods 16 patients with shrinking man syndrome undergoing hemodialysis were recruited. Parameters including general status, clinical manifestations, height, biochemical examinations (serum total calcium, inorganic phosphate, intact parathyroid hormone) were collected before and after operation.Results Their body weights increased from 2kg to 10kg and their body height changed little 3 month after operation. Bone malformation was remitted to some degree. Bone pain and skin pruritus were remitted rapidly within one day. Intact parathyroid hormone decreased significantly at 1 week after operation and maintained at low levels 1 month and 3 month after operation(20.4 ± 13.5pg/ml,36.3 ±17.4pg/ml,41.7 ± 23.9pg/ml vs 4120.7 ± 865.4pg/ml,respectively. t=18.95,18.88,18.85,respectively.P＜0.01).Compared with serum calcium levels before operation,those decreased rapidly at 1 week after operation. They were elevated slowly within 3 months after operation. However, compared those before operation, they remained lower levels(2.02 ± 0.19mmol/L, 2.28 ± 0.37 mmol/L,2.20 ±0.21 mmol/L vs 2.71 ± 0.22 mmol/L，respectively.t=9.49,4.00,6.71, respectively. P＜0.01). Compared with serum phosphate levels before operation, those after operation decreased rapidly at 1 week and maintained at normal levels 1 month and 3 month after operation (1.05 ± 0.21mmol/L, 1.08 ± 0.24mmol/L, 1.25 ± 0.31mmol/L vs 2.39 ± 0.29mmol/L, respectively. t=14.97,13.92,10.74, respectively. P＜0.01). Conclusions Total parathyroidectomy may be a effective and safely method on shrinking man syndrome in maintenance hemodialysis patients.

Key words: Shrinking man syndrome, Secondary hyperparathyroidism, total parathyroidectomy