中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (05): 256-260.doi: 10.3969/j.issn.1671-4091.2015.05.001

• 临床研究 •    下一篇

甲状旁腺切除术对尿毒症血透患者血磷及骨代谢的影响

李屾森,毛建萍,王梦婧,丁旻雯,张敏敏,袁立,黄碧红,陈靖   

  1. 复旦大学附属华山医院肾内科
  • 收稿日期:2015-02-25 修回日期:2015-03-23 出版日期:2015-05-12 发布日期:2015-05-29
  • 通讯作者: 陈靖 chenjing1998@vip.163.com E-mail:chenjing1998@fudan.edu.cn
  • 基金资助:

    国家自然科学基金(81170684) 上海市优秀学科带头人培养计划(XBR2013080)

Effects of parathyroidectomy on phosphate and bone metabolism in maintenance hemodialysis patients with secondary hyperparathyroidism

  • Received:2015-02-25 Revised:2015-03-23 Online:2015-05-12 Published:2015-05-29

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摘要： 目的探讨甲状旁腺切除术对尿毒症血液透析患者血磷及骨代谢的影响，分析影响血磷的主要因素。方法选取2008 年1 月～2013 年12 月在复旦大学附属华山医院接受甲状旁腺切除术的尿毒症继发性甲状旁腺功能亢进患者，收集患者术前1 天、术后1、3 和7 天的血清及血浆标本，检测各时间点各项血生化指标、调磷因子及骨代谢指标，并进行相关性分析。结果甲状旁腺切除术后各时间点(1、3、7 天)血甲状旁腺素(PTH)水平较术前明显下降，差异有统计学意义。同时，术后3 天的血磷水平从术前2.26±0.55mmol/L 明显下降至正常水平1.37±0.40mmol/L(P＜0.01)。术后血成纤维细胞生长因子23(FGF23)水平逐渐下降，至术后7 天与术前相比具有显著下降(418.65±280.74 pg/mL vs. 680.75±307.71 pg/mL)。同时，术后1 天血清骨特异性碱性磷酸酶(BAP) 由术前727.50 ± 30.14U/L 降至551.25± 60.61 U/L，Ⅰ型胶原交联羧基末端肽(ICTP)由术前20.11±2.56μg/L 降至13.75±2.95μg/L，差异均有统计学意义。相关性分析显示血磷与PTH、血钙、FGF23、25 羟维生素D3(25(OH)D3)、BAP 及ICTP均有显著相关性，但多因素回归分析证实血浆FGF23 水平是影响血磷的决定因素。结论甲状旁腺切除术可以显著纠正高磷血症，改善骨代谢异常，骨骼产生的FGF23 是决定血磷的关键因素。

关键词: 甲状旁腺切除术, 高磷血症, 成纤维细胞生长因子23, 骨代谢

Abstract: Objective To explore the effects of parathyroidectomy (PTX) on serum phosphate level and bone metabolism in uremic hemodialysis patients, and to analyze the primary factors which affect serum phosphate level. Method Uremic patients with secondary hyperparathyroidism treated with PTX in our hospital during the period from Jan. 2008 to Dec. 2013 were enrolled in this study. Serum and plasma samples were collected before PTX and after PTX for 1, 3 and 7 days and clinical data were recruited. Correlations among these data were analyzed. Result Serum PTH significantly decreased after PTX for one day as compared with the level before PTX. Serum phosphate decreased from 2.26±0.55 mmol/L before PTX to 1.37± 0.40 mmol/L after PTX for 3 days (P＜0.01). Plasma FGF23 also decreased gradually after PTX. Plasma FGF23 decreased from 680.75±307.71 pg/mL before PTX to 418.65±280.74 pg/mL after PTX for 7 days (P＜0.01). Serum bone- specific alkaline phosphatase (BAP) reduced from 727.50 ± 30.14 U/L before PTX to 551.25±60.61 U/L after PTX for one day (P＜0.01). Serum type I collagen cross-linked C-terminal peptide (ICTP) decreased from 20.11±2.56 μg/L before PTX to 13.75±2.95 μg/L after PTX for one day (P＜0.05).Pearson correlation analysis found that serum phosphate level correlated with the levels of serum PTH, calcium, FGF23, 25(OH)D3 BAP and ICTP. Multivariate regression analysis demonstrated that FGF23 was the factor determining serum phosphate level. Conclusion Parathyroidectomy significantly alleviates the higher serum phosphate and improves bone metabolism. Bone derived FGF23 is a decisive factor on serum phosphate level.

Key words: Parathyroidectomy, Hyperphosphatemia, Fibroblast growth factor 23, Bone metabolism