CKD-MBD患者甲状旁腺切除术疗效观察  

The effect of parathyroidectomy of CKD-MBD patients

作　　者：丁婷[1] 许辉[1] 常实[2] 甘露[1] 黄鹏[2] 周巧玲[1] 

机构地区：[1]中南大学湘雅医院肾内科,湖南长沙410008 [2]中南大学湘雅医院普外科,湖南长沙410008

出　　处：《国际泌尿系统杂志》2015年第2期248-252,共5页International Journal of Urology and Nephrology

摘　　要：目的 调查本院维持透析并发慢性肾脏病矿物质及骨代谢紊乱（chronic kidney diseasemineral and bone disorder,CKD-MBD）患者在接受甲状旁腺切除术（parathyroidectomy,PTX）后,血钙、血磷及血清全段甲状旁腺素（intact parathyroid hormone,iPTH）的恢复情况,追踪PTX的手术疗效.方法 检测19例行甲状旁腺全切加前臂自体移植术的CKD-MBD患者术前及术后的血钙、血磷及血iPTH,比较患者术前和术后的血钙、血磷、血iPTH的变化.结果 术后0d、1d、7d、15d血钙较术前明显下降,差异有统计学意义（P ＜0.01）,通过术后规律补钙,术后1个月、3个月、6个月、12个月与术前血钙比较,差异无统计学意义（P＞0.05）,术后低血钙发生率为21％,无高钙血症发生.术后0d、1d、7d、15d、1个月、3个月、6个月、12个月血磷与术前血磷比较明显下降,差异有统计学意义（P ＜0.01或P＜0.05）.术后低血磷发生率为33.3％,无高磷血症发生.术后0d、1d、7d、1个月、3个月、6个月、12个月的血iPTH较术前下降明显,差异有统计学意义（P＜0.01）.随访中有2例出现低iPTH（iPTH＜ 16pg/mL）血症,2例iPTH升高明显,均＞800pg/mL.结论 CKD-MBD患者行甲状旁腺全切加前臂自体移植术后血钙、血磷、血iPTH可恢复正常范围.Objectives To check the effect of parathyroidectomy （PTX） by investigating the recovery of the serum calcium,serum phosphorus and serum intact parathyroid hormone （iPTH） of dialysis patients with chronic kidney disease complicated by mineral and bone metabolism disorders（CKD-MBD） in our hospital.Methods Compared the levels of serum calcium,serum phosphorus and serum iPTH preoperative and postoperative.Results The postoperative 1 day,7 days,15 days decreased comparing with the preoperative serum calcium significantly（P 〈 0.01）,The difference of serum calcium among postoperative 1 month,3month,6month,12month and preoperative isnt significant（P 〉 0.05）,the incidence rate of hypocalcemia is 21%,no hypercalcemia patient.The postoperative 1 day,7 days,15 days,1 month,3 months,6 months and 12 months decreased comparing with the preoperative serum phosphate significantly（P 〈0.01 or P 〈 0.05）.The incidence rate of hypophosphatemia is 33.3%,no hyperphosphatemia patient.The postoperative 0 days,1 day,15 days,1 month,3 months,6 months and 12 months decreased comparing with the preoperative blood iPTH,significant（P 〈0.01）.In the following period,2 patients showed low iPTH （iPTH 〈 16pg/ml）,iPTH increased significantly in 2 people,both 〉 800pg/mL.Conclusions The serum calcium,phosphorus and iPTH can return to normal range after PTX in those most CKD-MBD patients.

关 键 词：肾疾病 甲状旁腺功能亢进症 甲状旁腺切除术 

分 类 号：R692[医药卫生—泌尿科学]