中国血液净化

›› 2005, Vol. 4 ›› Issue (8): 416-419.

• 论著 • 上一篇    下一篇

甲状旁腺切除术对伴重度继发性甲状旁腺功能亢进维持性透析患者肾性贫血的影响

匡鼎伟 薛 骏 丁 峰 李铭新 陈 靖 李海明 陆福明 顾 勇 林善锬
  

  1. 200040 上海，上海复旦大学附属华山医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2005-08-12 发布日期:2005-08-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2005-08-12 Published:2005-08-12

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摘要：

目的 评价甲状旁腺全切除＋部分前臂自体移植术（PTX+FAT）对伴有重度继发性甲状旁腺功能亢进(SHPT)的维持性透析患者肾性贫血的影响。方法 取复旦大学华山医院2001～2005年22例伴有重度SHPT的维持性血液透析患者，其中PTX组11例，非PTX组11例。观察术前、术后第3、6、12个月时患者的iPTH、贫血、铁代谢、营养、透析充分性指标，同时记录患者促红细胞生成素用量、干体重、超滤量等数据。结果 PTX组患者术后血清iPTH迅速下降，从第3个月起差异有显著统计学意义(P＜0.01)；贫血逐步改善，至术后第12个月时血红蛋白和红细胞压积较术前显著升高(P＜0.01及P＜0.05)，与非PTX组相比差异有显著性意义(P＜0.05)，同时患者促红细胞生成素用量自第6个月起较术前明显减少，与非PTX组比较差异有统计学意义(P均＜0.01)；血清铁及转铁蛋白饱和度在术后12个月时较术前明显升高(P＜0.01)；前白蛋白水平自术后第6个月时也明显升高(P＜0.01)。与非PTX组相比铁蛋白、C反应蛋白、透析充分性等指标差异无统计学意义(P＞0.05)。结论 重度SHPT血液透析患者在PTX+FAT术后可迅速降低iPTH水平并显著改善肾性贫血、减少促红细胞生成素用量，其作用可能部分与功能性缺铁及营养状况改善有关。

关键词: 继发性甲状旁腺功能亢进, 肾性贫血, 甲状旁腺切除术

Abstract: Objective To evaluate the effects of parathyroidectomy (PTX) on renal anemia in maintenance hemodialysis (MHD) patients with severe secondary hyper-parathyroidism (SHPT). Methods Twenty-two MHD patients with severe SHPT in Huashan Hospital Dialysis Center were divided into two groups: Eleven patients who underwent total PTX + partial forearm autotransplan- tation (FAT) were enrolled in PTX Group and others were in Non-PTX Group. The iPTH and anemia levels, iron homeostasis, dose of rHuEPO requirement and nutritional state were assessed before and 3, 6, 12 months after PTX + FAT. Results The iPTH level was decreased gradually from 3 months after PTX + FAT. The hemoglobin level and hematocrit showed a significant increase at 12 months after PTX + FAT, associated with a remarkable decreased rHuEPO dose requirement from 6 months after PTX + FAT and a significant difference was also found between two groups at the same time. The serum iron and transferrin saturation levels showed a significant increase at 12 months after PTX + FAT. Concomitantly, the pre-albumin level was gradually higher from 6 months after PTX + FAT. We found no statistically significant differences in CRP, ferritin and the adequacy of dialysis between two groups. Conclusion We conclude that PTX +FAT can improve renal anemia in hemodialysis patients with severe SHPT and greater resistance to rHuEPO therapy. It may be partially due to the improved functional iron deficiency and nutritional state after PTX+FAT.

Key words: Renal anemia, Parathyroidectomy

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