甲状旁腺切除术对终末期肾脏疾病患者冠状动脉钙化的影响  

Effect of parathyroidectomy on coronary artery calcification of patient with end-stage renal diseases

作　　者：郑学[1] 缪蕙[1] 张欣洲[1] 贺晓蕾[1] 李涌泉[1] 王康[1] 郭宝春[1] 

机构地区：[1]广东省深圳市暨南大学第二临床医学院深圳市人民医院肾内科,518020

出　　处：《临床肾脏病杂志》2011年第2期68-70,共3页Journal Of Clinical Nephrology

摘　　要：目的 评价甲状旁腺切除术（PTX）对终末期肾脏疾病（ESRD）患者冠状动脉钙化（CAC）的影响.方法 收集2008年1月至2009年5月我院30例行PTX的ESRD患者资料,对患者进行多层螺旋CT扫描,再根据Agaston方法计算CAC积分,比较存在CAC者手术前、后CAC积分.比较患者手术前、后甲状旁腺素、血钙、血磷、钙磷乘积,同时观察患者临床症状、体征的改善情况以及术后并发症、不良反应等.结果 本组30例,有CAC者20例,占66.7%;无CAC者10例,占33.3%.本组患者手术后第6、12个月甲状旁腺素、血钙、血磷、钙磷乘积和CAC积分均较手术前降低（P＜0.05）.PTX可改善患者皮肤瘙痒、骨痛、关节痛等症状,不会导致难以纠正的低钙血症,手术后无明显不良反应及并发症,近1年内无一例复发.结论 PTX可安全有效的降低ESRD患者甲状旁腺素水平,改善钙磷代谢紊乱,并控制CAC的进展.Objective To evaluate the effect of parathyroidectomy （PTX） on coronary artery calcification （CAC） and calcium and phosphate abnormality of patients with end-stage renal diseases （ESRD）. Methods Thirty ESRD patients with severe secondary hyperparathyroidism （SHPT） who underwent PTX in our division were enrolled in this study. Multislice spiral computed tomography （MSCT） was done, and CAC score was calculated by Agaston method. Parathyroid hormone （PTH）, serum calcium and phosphate, and CAC score were recorded before and 6, 12 months after PTX. Meanwhile, clinical symptoms and negative symptoms of PTX were also evaluated. Results Serum calcium and phosphate, the product of calcium and phosphate, and PTH were decreased gradually 6, 12 months after PTX as compared with those before PTX. Concomitantly, the CAC was gradually reduced from 6 months after PTX. Symptoms such as the skin pruritus, bone-arthrosis pain, restless legs syndrome and insomnia were improved significantly after PTX. There was no significant serious negative symptom. Conclusions PTX can reduce the PTH level and correct calcium and phosphate abnormality safely and effectively. It can prevent or reverse progression of CAC.

关 键 词：冠状动脉钙化 甲状旁腺切除术 肾透析 

分 类 号：R692[医药卫生—泌尿科学]