中国血液净化

›› 2011, Vol. 10 ›› Issue (5): 250-253.doi: 10.3969/j.issn.1671-4091.2011.05.00

• 临床研究 • 上一篇    下一篇

甲状旁腺切除术改善继发性甲状旁腺功能亢进症维持性血液透析患者生活质量

赵文燕 张 凌 谢亚平 苏 默 周 莉 李文歌 卞维静   

  1. 中日友好医院肾内科
  • 收稿日期:2011-04-06 修回日期:1900-01-01 出版日期:2011-05-12 发布日期:2011-05-12

Parathyroidectomy improves life quality in maintenance hemodialysis patients with secondary hyperparathyroidism

ZHAO Wen-yan, ZHANG Ling, XIE Ya-ping, SU Mo, ZHOU li, LI Wen-ge, BIAN Wei-jing.   

  1. Department of Nephrology, China-Japan Friendship Hospital, Beijing 100029, China
  • Received:2011-04-06 Revised:1900-01-01 Online:2011-05-12 Published:2011-05-12

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摘要：

目的 评价甲状旁腺切除术(parathyroidectomy,PTX)对伴有继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)的维持性透析患者生活质量的影响。 方法 选取2004年至2010年中日友好医院的维持性血液透析患者，其中因难治性SHPT实行PTX组33例，非PTX组35例。收集PTX组手术前和术后1年，非PTX组1年前、后的数据，包括血钙、血磷、碱性磷酸酶(alkaline phosphatase,ALP)及血清全段甲状旁腺激素(intact parathyroid hormone,iPTH)；应用简明健康测量量表(medical outcomes study 36-item short-form health survey,SF-36)调查，分析量表各维度得分并进行比较。 结果 钙、磷、ALP、iPTH：PTX组术前与非PTX组比较各项指标均明显升高(均P＜0.05)；PTX组术后1年与术前比较各项指标均明显减低(均P＜0.01)。SF-36量表各维度得分：PTX组术前与非PTX组比较在生理功能、躯体疼痛2个维度有减低(P＜0.01)；PTX组术后1年与术前比较在生理功能、躯体疼痛、情感职能、精神健康4个维度有明显提高(P＜0.01)；PTX组术后与非PTX组1年后比较，在生理功能、情感职能及躯体疼痛3个维度有提高(P＜0.05)。 结论 PTX不仅可以有效治疗难治性SHPT，而且可以明显提高患者生活质量。

关键词: 继发性甲状旁腺功能亢进, 甲状旁腺切除术, 生活质量, 简明健康测量量表

Abstract:

Objective To evaluate the effects of parathyroidectomy (PTX) on life quality in maintenance hemodialysis patients with secondary hyperparathyroidism (SHPT). Methods A total of 68 maintenance hemodialysis cases treated in this hospital during the period of 2004 to 2010 were included in this study. They were divided into 2 groups: PTX for the refractory SHPT (PTX group, 33 cases), and non-PTX group (35 cases). Serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP) and intact PTH (iPTH) were determined in the PTX group before PTX and within one year after PTX and in the non-PTX group within one year. Patients’ life quality was evaluated using Health Status Questionnaire Short Form-36 (SF-36) Scale, and the scores were analyzed and compared. Results (a) The preoperative serum Ca, P, ALP and iPTH were significantly higher in the PTX group than in the non-PTX group (P＜0.05 or P＜0.001). In the PTX group, serum Ca, P, ALP and iPTH after PTX for one year were significantly lower than those before PTX (P＜0.001). (b) In the PTX group before PTX, the SF-36 scale scores of physical health (PF) and bodily pain (BP) were significantly lower as compared with those in the non-PTX group (P＜0.01). After PTX for one year in the PTX group, the scores of PF, BP, emotional role function (RP) and mental health (MH) were significantly elevated, as compared with those before PTX (P＜0.001), and the scores of PF, RP and BP were also higher than those in the non-PTX group after one year (P＜0.05). Conclusion PTX is an effective measure to improve the life quality of maintenance hemodialysis patients with refractory SHPT.

Key words: Parathyroidectomy, Life quality, SF-36 scores