中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (11): 759-762.doi: 10.3969/j.issn.1671-4091.2014.11.005

• 临床研究 • 上一篇    下一篇

甲状旁腺切除对血液透析患者心血管钙化影响的初步探讨

高卓1,刘东1,张凌2,李寒3,缪静1,伦立德1   

  1. 1. 空军总医院肾病科
    2. 卫生部中日友好医院肾内科
    3. 首都医科大学附属北京朝阳医院血液净化中心
  • 收稿日期:2014-06-05 修回日期:2014-09-05 出版日期:2014-11-12 发布日期:2014-11-12
  • 通讯作者: 伦立德 15611161117@163.com E-mail:lunlideldm@163.com
  • 基金资助:

    北京首都临床特色应用研究基金(Z111107058811085)资助

Impact of parathyroidectomy on cardiovascular calcification in maintenance hemodialysis patients

  • Received:2014-06-05 Revised:2014-09-05 Online:2014-11-12 Published:2014-11-12

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摘要： 目的观察甲状旁腺切除术(PTX)对伴有继发性甲状旁腺功能亢进症(Secondary Hyperparathyroidism, SHPT)的血液透析患者钙磷代谢以及动脉钙化、动脉僵硬度情况的影响。方法选取21 例有继发性甲状旁腺功能亢进的血液透析患者，行甲状旁腺切除术，对患者术前、术后1 年应用多层螺旋CT检测冠状动脉钙化积分，并测臂踝脉搏波传导速度(baPWV)，同时将患者术前、术后1 年的血钙、血磷、钙磷乘积、PTH 等指标进行比较。结果与术前比较，术后1 年患者冠状动脉钙化积分有明显减低(P=0.0236)，左右两侧肢体臂踝脉搏波传导速度(baPWV)平均值减少(P=0.0034, P=0.0012)，差异性有统计学意义；术后血钙、血磷、钙磷乘积、PTH 水平均明显降低，差异性有统计学意义(P 分别为0.0004,0.0002,0.0000,0.0000)。结论甲状旁腺切除术(pTx)能纠正钙磷代谢紊乱，减轻动脉钙化程度，改善动脉僵硬度。

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, 臂踝脉搏波传导速度

Abstract: 【Abstract】Objective To observe the impact of parathyroidectomy (PTX) on calcium and phosphorus metabolism, arterial calcification and arterial stiffness in maintenance hemodialysis (MHD) patients complicated with secondary hyperparathyroidism (SHPT). Methods A total of 21 MHD patients with SHPT were subjected to PTX. Their coronary artery calcification score based on the multi-slice spiral CT images, brachial-ankle pulse wave velocity (baPWV), serum calcium, phosphorus, calcium-phosphorus product, and serum PTH were compared before PTX and after PTX for one year. Results After PTX for one year, coronary artery calcification score decreased significantly (P=0.0236), so did the mean baPWVs of bilateral limbs (P=0.0034 and 0.0012 for left and right limbs, respectively), as compared with those before PTX. Serum calcium, phosphorus, calcium-phosphorus product, and PTH also reduced after PTX (P=0.0004, 0.0002, <0.0001 and <0.0001, respectively). Conclusions PTX improved calcium and phosphorus metabolism, and reduced arterial calcification and stiffness in MHD patients with SHPT.

Key words: hemodialysis, secondary hyperparathyroidism, parathyroidectomy, coronary artery calcification score, brachial-ankle pulse wave velocity