中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (07): 408-411.doi: 10.3969/j.issn.1671-4091.2015.07.007

• 临床研究 • 上一篇    下一篇

甲状旁腺切除术对血液透析患者冠状动脉钙化进展的影响

阚森,张倩,王梦婧,丁旻雯,张敏敏,黄碧红,袁立,陈靖   

  1. 复旦大学附属华山医院肾病科，复旦大学肾脏病研究所
  • 收稿日期:2015-02-25 修回日期:2015-04-02 出版日期:2015-07-12 发布日期:2015-07-12
  • 通讯作者: 张倩 qianzhang1105@163.com E-mail:chenjing1998@fudan.edu.cn
  • 基金资助:

    国家自然科学基金(81170684, 81400745)，上海市科技英才扬帆计划(14YF1400900)

Impact of parathyroidectomy on the progression of coronary artery calcification in maintenance hemodialysis patients

  • Received:2015-02-25 Revised:2015-04-02 Online:2015-07-12 Published:2015-07-12

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摘要： 【摘要】目的观察甲状旁腺切除术(parathyroidectomy，PTX)对伴有继发性甲状旁腺功能亢进症(Secondary Hyperparathyroidism, SHPT)的血液透析患者冠状动脉钙化(Coronary artery calcification，CAC)进展的影响，并分析CAC 进展的相关因素。方法37 例维持性血液透析(maintenance hemodialysis，MHD)患者，其中9 例因难治性SHPT 行甲状旁腺切除术，另外28 例未做手术。基线以及随访时均应用多层螺旋CT 检测CAC 积分，比较2 组CAC 积分进展情况以及血钙、血磷、iPTH 等指标，采用单因素和多因素回归分析CAC 进展和临床参数的相关性。结果手术组患者随访血钙、血磷、iPTH 水平分别为(2.1±0.3)mmol/L、(1.3±0.5) mmol/L 和(82.1±96.6)mmol/L,较基线(2.5±0.4)mmol/L、(1.8±0.4)mmol/L 和(846.6±588.4)mmol/L 均明显降低，差异有统计学意义(P 均＜0.05)。与基线CAC 积分比较，患者随访CAC 积分有明显升高，但2 组患者CAC 进展速度(128.9±169.9)分/年和(137.5±143.3)分/年无显著性差异；单因素与多因素回归分析显示CAC 进展与iPTH 水平改变、平均血钙磷水平等均无相关性，与糖尿病和基线CAC 积分水平存在相关性(P 分别为0.002 和0.001)。结论甲状旁腺切除术可以显著改善血液透析患者的钙磷代谢紊乱，但并未改善CAC 进展情况，糖尿病和基线CAC 积分可能影响CAC的进展。

关键词: 血液透析, 继发性甲状旁腺功能亢进, 甲状旁腺切除术, 冠状动脉钙化积分

Abstract: 【Abstract】Objective To observe the impact of parathyroidectomy (PTX) on the progression of coronary artery calcification (CAC) in maintenance hemodialysis (MHD) patients complicated with secondary hyperparathyroidism (SHPT), and to analyze the factors contributing to the progression of CAC. Methods A total of 37 MHD patients were enrolled in this study. Nine of them underwent PTX due to refractory SHPT, and 28 of them without PTX were used as controls.Computed tomographic imaging was performed at baseline and in follow-up period to obtain the changes of CAC score. CAC score, serum calcium, phosphorus and iPTH at baseline and in follow-up period were compared between the two groups. Results In PTX group, serum calcium, phosphorus and iPTH at follow-up period after PTX were 2.1±0.3 mmol/L, 1.3±0.5 mmol/L and 82.1±92.6 mmol/L, respectively, significantly lower than those at baseline (P＜0.05). The general CAC score in follow-up period increased significantly, but the annualized change of CAC score was indifferent between the two groups. Progression of CAC was significantly associated with diabetes and baseline CAC score (P=0.0002 and 0.0001, respectively), but not with serum iPTH. Conclusions PTX improved calcium and phosphorus metabolism, but had no effect on the progression of CAC in MHD patients with SHPT. Diabetes and baseline CAC score may affect the progression of CAC.

Key words: Hemodialysis, Secondary hyperparathyroidism, Parathyroidectomy, Coronary artery calcification
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