中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (12): 732-735.doi: 10.3969/j.issn.1671-4091.2015.12.009

• 基础研究 • 上一篇    下一篇

甲状旁腺激素与尿毒症继发甲状旁腺功能亢进术后病理的相关性研究

王继伟1,张兵林2,张凌3   

  1. 1. 吉林市中心医院
    2. 中日友好医院病理科
    3. 中日友好医院肾内科
  • 收稿日期:2015-06-24 修回日期:2015-09-24 出版日期:2015-12-12 发布日期:2015-12-12
  • 通讯作者: 张凌zhangling5@medmail.com.cn E-mail:wangjiwwei@126.com

Correlation study between parathyroid hormone level and pathological findings of parathyroid surgical samples in uremic patients with hyperparathyroidism

  • Received:2015-06-24 Revised:2015-09-24 Online:2015-12-12 Published:2015-12-12

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摘要： 目的通过对尿毒症继发难治性甲状旁腺功能亢进行甲状旁腺切除术后的甲状旁腺组织病理观察，分析不同程度甲状旁腺激素水平患者的病理结果是否存在差异。方法在2009 年9 月～2012年1 月期间在中日友好医院进行甲状旁腺切除手术(PTX)的46 例尿毒症透析患者的甲状旁腺组织进行病理形态分析。根据甲状旁腺激素(iPTH)水平分组，A 组iPTH＜1000pg/ml，B 组iPTH1000pg/ml～2000pg/ml，C 组iPTH＞2000pg/ml；同时依据透析龄10 年以上和10 年以下分2 组。比较3 组间实验室指标的差异及甲状旁腺组织的病理形态差异；比较不同透析龄分组，甲状旁腺组织的病理形态差异。结果3 组间Ca、P 和透析龄之间均无显著性差异(P＞0.05)；3 组iPTH 组间均有显著性差异(P =0.000)；3 组间比较碱性磷酸酶(ALP)有显著性差异[（216.00±196.81）U/L,(463.45±363.35)U/L,(619.55±377.50)U/L,P =0.014]，ALP 的组间均值随iPTH 的升高而大幅度升高，与iPTH 的升高成正比。病理形态比较3 组中均出现陈旧性出血、嗜酸性细胞、水样透明细胞、腺样结构及病变区钙化和血管壁钙化等病变。以透析龄10年为界进行比较，甲状旁腺出现钙化、血管壁钙化的比例分别为透析10 年以下组23.1%和透析10 年以上组78.9%，2 组间具有显著性差异(P =0.000)。结论iPTH 的水平与ALP 的升高呈正相关；钙化和血管壁钙化与透析时间长短相关；而iPTH水平的高低与继发甲状旁腺功能亢进病理变化无相关性。

关键词: 继发性甲状旁腺功能亢进, 甲状旁腺激素, 碱性磷酸酶, 透析龄

Abstract: Objectives To analyze the relationship between parathyroid hormone (PTH) level and pathological changes in parathyroid of hyperparathyroidism through pathological examination of the surgical samples after parathyroidectomy (PTX). Methods A total of 46 dialysis patients with refractory hyperparathyroidism
and treated with PTX in China-Japan Friendship Hospital during the period from Sep. 2009 to Jan. 2012 were enrolled in this study. They were divided into 3 groups based on iPTH level: group A (iPTH ＜1,000 pg/ml), group B (iPTH 1,000～2,000 pg/ml), and group C (iPTH >2,000 pg/ml). They were also divided
into dialysis age >10 years group and dialysis age <10 years group. Laboratory examinations and pathological findings in the parathyroid surgical samples were compared among the 3 groups. Pathological findings in the parathyroid surgical samples were also compared in patients with different dialysis age. Results Ca, P and dialysis age had no differences (P＞0.05), but iPTH and alkaline phosphatase (ALP) levels were significantly different among the 3 groups (P =0.000 and 0.014, respectively). Group C had the highest mean ALP value, followed by group B and group A. Old hemorrhagic foci, eosinophilic cells, transparent cells, adenoid structure, tissue calcification, and vascular wall calcification were seen in the 3 groups. The rate of calcification in parathyroid gland and vascular wall was 23.1% in patients with dialysis age of <10 years, and was 78.9% in those with dialysis age of >10 years (P=0.000). Conclusion iPTH levels were positively correlated with the level of ALP. Calcification in parathyroid gland and vascular wall was positively correlated with dialysis age. However, iPTH level was unrelated to the pathological changes of hyperparathyroidism in parathyroid.

Key words: secondary hyperparathyroidism, Parathyroid hormone, alkaline phosphatase, dialysis age