21例尿毒症患者甲状旁腺全切加前臂移植对改善透析患者肾性贫血的临床观察  

Total parathyroidectomy with partial forearm autoplastic transplantation for renal anemia in 21 cases of uremia subject to maintenance hemodialysis

作　　者：张丽娟[1,2] 沈良儒[2] 

机构地区：[1]南京大学医学院研究生,南京210032 [2]江苏省泗洪县分金亭医院肾内科,223900

出　　处：《临床肾脏病杂志》2014年第3期164-168,共5页Journal Of Clinical Nephrology

摘　　要：目的探讨甲状旁腺全切除加部分前臂自体移植术（parathyroidectomy＋forearyauto—transplantation，PTX＋FAT）纠正重度继发性甲状旁腺功能亢进（secondaryhyperparathyroidism，SHPT）对维持性透析（maintenancehemodialysis，MHD）患者并发难治性肾性贫血的影响。方法选择MHD并发重度SHPT及难治性肾性贫血患者21例，均为经规范的药物治疗无效者行PTX＋FAT治疗，观察术前、术后第3、6、12个月时患者的血清全段甲状旁腺素（intactparathyroidhormone，i盯H）、钙（Ca）、磷（P）、血红蛋白（Hb）、红细胞压积（Hct）、血清铁蛋白（SF）、转铁蛋白饱和度（TSAT）、血清白蛋白（Alb）、KT／V等指标变化，同时记录患者的促红细胞生成素（recombinanthu—manerythropoietin，rHuEPO）用量。结果所有患者与术前相比血清iPTH、Ca、P迅速下降，从术后第3个月开始贫血得到逐步改善，术后第12个月Hb和Hct较术前显著升高（P〈0．05），术后第6个月rHuEPO用量减少，与术前相比差异显著（P〈0．01），术后第12个月rHuEPO用量大幅减少，与术前相比有显著性差异（P〈O．01）。手术前、后SF、TSAT、Alb、KT／V等指标差异无统计学意义（P〉0．05）。结论重度SHPT维持性血液透析患者在PTX＋FAT术后可迅速降低iPTH水平并显著改善MHD患者的难治性肾性贫血，减少rHuEPO用量，提示重度SHPT是影响肾性贫血的一个重要因素，其作用可能部分与rHuEPO抵抗有关。Objective To investigate effect of total parathyroidectomy with partial forearm auto- plastic transplantation（PTX＋ FAT） which aims to correct the severe secondary hyperparathyroidism （SHPT） on refractory renal anemia in maintenance hemodialysis （MHD）patients. Methods Twenty＂ one MHD patients complicated by severe SHPT and refractory renal anemia were chosen, whose stand- ard drug therapy was invalid, and were subjected to PTX ＋ FAT. The changes in the intact parathyroid hormone（iPTH）, calcium （ Ca ）, phosphorus （ P ）, hemoglobin （ Hb ）, hematocrit （Hct ）, serum ferritin （SF）, transferrin saturation（TSAT）, serum albumin（Alb）, KT/V, etc, were observed before and at the third, sixth and twelfth months after the surgery, and at the same time, the dosage of recombinant hu- man erythropoietin（rHuEPO） was recorded. Results As compared with those before the surgery, iPTH, Ca and P in all patients were dropped rapidly, and the anemia was gradually improved, from the third month after the surgery. From the twelfth month after the surgery, the hemoglobin and the hema- tocrit were significantly increased as compared with those before the surgery （P〈0. 05）. The dosage of rHuEPO was reduced obviously（P〈0. 05 or P〈0. 01） from the sixth month after the surgery as compared with that before the surgery. Meanwhile, there was no significant difference in the indexes of SF,TSAT,Alb and KT/V, before and after the surgery （P〉0. 05）. Conclusions For the severe SHPT maintenance hemodialysis patients,iPTH level could be rapidly decreased and the refractory renal anemia of the MHD patients could be significantly improved, and the dosage of rHuEPO could be reduced as well after the PTX ＋ FAT surgery. There is a hint that severe SHPT is an important factor affecting renal anemia, and its function may partly be related to rHuEPO resistance.

关 键 词：尿毒症 甲状旁腺 贫血 

分 类 号：R459.5[医药卫生—治疗学]