【摘要】 目的：研究难治性继发性甲状旁腺功能亢进症(secondary hyperparathyroidism，SHPT)患者心脏结构与功能的特点及相关因素。方法：回顾性总结82例行甲状旁腺切除术(parathyroidectomy，PTX)治疗的维持性血液透析患者（maintenance hemodialysis，MHD），其中男44例，女38例，平均年龄46.7±14.1岁(25～73岁)；平均透析龄128.5±49.6月(36～216月)。30例同期维持性血透患者作为对照组。均于透析前测定血清肌酐(serum creatinine，Scr)、白蛋白(albumin，Alb) 、钙(calcium，Ca2+) 、磷(phosphorus，P) 、碱性磷酸酶(alkalinephosphatase，ALP)、血红蛋白(hemoglobin，Hb)，全段甲状旁腺素(intact parathyroid hormone，iPTH)等指标，超声心动图测量心脏结构和功能的相关指标，根据公式计算出左心室心肌质量指数（L eft ventricular mass index, LVMI）,然后分析其相关关系。结果　PTX组与普通血透患者相比，LVH、左室收缩功能不全、左室舒张功能不全的发生率明显升高(依次为96.3%和63.33%、79.27%和43.33%、75.6%和26.6%)（P <0.05或P <0.01），瓣膜钙化显著（P <0.01）。进一步的多因素回归分析显示, LVMI与透析龄、血磷、血iPTH呈正相关(r依次为0.47、0.76、0.68，P均<0.05)。结论　难治性继发性甲状旁腺功能亢进症患者左心室肥厚(LHV)、左室功能异常较普通血透患者更常见，程度更重，此类患者可考虑尽早行PTX，以降低其心血管疾病死亡率。

Objective To analyze the characteristics of cardiac structure and function and the related factors in patients with refractory secondary hyperparathyroidism (SHPT). Methods A total of 82 end-stage renal disease cases with refractory SHPT and treated with parathyroidectomy (PTX) were retrospectively studied. There were 44 males and 38 females with average age of 46.7±14.1 years old and average dialysis duration of 128.5±49.6 months (36～216 months). Thirty maintenance hemodialysis (MHD) patients treated at the same period were used as the control group. Serum creatinine (Scr), albumin (Alb), calcium (Ca2+), phosphorus (P), alkaline phosphatase (ALP), hemoglobin (Hb) and intact parathyroid hormone (iPTH) were assayed before hemodialysis. LVDd, IVS, PWTH, EF and E/A were measured by echocardiography. LVMI was calculated by a formula, and the relationship between LVMI and clinical indices was then analyzed. Results Compared with the control group, the PTX group had significantly higher rates of left ventricular hypertrophy (96.3% vs. 63.33%), left ventricular systolic dysfunction (79.27% vs. 43.33%), left ventricular diastolic dysfunction (75.6% vs. 26.6%), and valve calcification (P<0.05 or <0.01). Multivariate linear regression analysis showed a positive correlation between LVMI and the values of dialysis duration, serum P and iPTH (r=0.47, 0.76, and 0.68, respectively; P<0.05). Conclusion End-stage renal disease patients with refractory SHPT had higher incidences and severer degrees of left ventricular hypertrophy and left ventricular dysfunction than other MHD patients. PTX should be considered for patients with refractory SHPT to reduce their cardiovascular mortality.