终末期肾病患者甲状旁腺激素与心肌损伤的相关性研究  

The Correlation between Parathyroid Hormone and Myocardial Damage in Patients with End Stage Renal Disease

作　　者：周芸[1] 李荣山[2] 王丽娟[1] 吴力翔[1] 郭晓晶[1] 郭瑜玲[1] 

机构地区：[1]山西医科大学第一医院,太原030001 [2]山西医科大学第二医院肾内科,太原030001

出　　处：《医学研究杂志》2009年第4期61-64,共4页Journal of Medical Research

摘　　要：目的探讨ESRD患者甲状旁腺激素与心肌损伤的相关关系。方法选择新收治的ESRD血液透析患者89例,在首次透析前检测血BUN、SCr、CK-MB、Hb及iPTH、cTnI等指标,超声心动图测量心脏结构和功能相关指标。其中32例患者iPTH>200ng/L给予阿法迪三冲击治疗,当iPTH≤200ng/L时复查上述指标。分析iPTH与cTnI和心脏结构相关指标的关系。结果ESRD患者中75.3%iPTH升高,57.3%cTnI升高。所有患者中70.8%存在左心室肥厚(LVH),治疗组中LVH高达87.5%。无论治疗前后iPTH与cTnI均呈正相关。同时iPTH与BUN、SCr、Hb正相关,而与CK-MB无关;与LVDd、IVSdT、LVP-WdT、LVMI正相关,而与LA、EF无关。cTnI和年龄、BUN、SCr等无关,而与LVMI呈线性相关。结论继发性高甲状旁腺激素血症(SHPT)在ESRD患者中常见,cTNI升高与LVH也很常见。SHPT与心肌损伤关系密切,治疗SHPT有助于改善LVH和减轻心肌损伤,从而改善ESRD远期预后。Objective To approach the correlation between parathyroid hormone（PTH） and myocardial damage in patients with end stage renal disease. Methods 89 ESRD patients were admitted for hemodialysis（HD）. The levels of BUN, serum creatinine（SCr） , MB isoenzyme of creatine kinase （ CK - MB） , hemoglobin （Hb） , and intact parathyroid hormone （iPTH） , cardiac troponin I （cTnI） were tested in all patients before hemodialysis. LA, IVSdT, LVDd, LVPWdT and EF values were detected by echoc ardiography at the same time. The blood tests and echocardiography came out before the first HD, and the left ventrieular mass index was calculated. 32 patients（treat group） with iPTH levels above 200 ng/L received pulse（2 p,g twice weekly or thrice weekly） oral alfacalcidol. After iPTH level 〈200 ng/L in 2 - 4 months, the blood tests and echocardiography came out once again. Statistical analysis of the data was performed by SPSS software. Resuits Increased iPTH and cTnI levels were found in 75.3% and 57.3% of these patients, respectively. There were 70.8% in ESRD patients with Left ventrieular hypertrophy（LVH） , LVMI159.48± 67.22g/m2, and 87.5% in treat group with LVH. The increased iPTH in ERSD patients had positive correlation with cTnl no matter before or after alfacalcidol treat, and had positive correlation with BUN, SCr, Hb and LVDd, IVSdT, LVPWdT, LVMI. The cTnI had positive correlation with LVMI, and had no correlation with age, BUN, SCr. Conclusion Secondary Hyperparathyroidism（SHPT） was common in ESRD patients, and there is a high incidence of myocardial damage in these patients. A close correlation exists between iPTH and cTnI and between iPTH and LVH. Higher iPTH levels are associated with a high prevalence of myocardial damage, and the therapy of antihyperparathyroidism was helpful to reduce IWH and cTnI.

关 键 词：终末期肾病 继发性甲状旁腺功能亢进 心肌损伤 肌钙蛋白 左心室肥厚 

分 类 号：R692.5[医药卫生—泌尿科学] R542.2[医药卫生—外科学]