甲状旁腺切除加自体前臂移植术治疗维持性血液透析继发性甲状旁腺功能亢进症疗效分析  

The treatment of total parathyroidectomy and forearm autotransplantation to maintenance hemodialysis patients with secondary hyperparathyroidism

作　　者：徐天华[1] 刘芳婕 王力宁[1] 马健飞[1] 冯江敏[1] 姚丽[1] 

机构地区：[1]中国医科大学附属第一医院肾内科,沈阳110001

出　　处：《中国实用内科杂志》2015年第6期522-524,共3页Chinese Journal of Practical Internal Medicine

基　　金：国家"十二五"科技支撑计划项目子课题(2011BAI10B02);辽宁省科技厅社会发展攻关计划(2013225303);辽宁省教育厅高等学校科研项目(L2011134);卫生公益性行业科研专项(201502010)

摘　　要：目的研究甲状旁腺切除加自体前臂移植术对维持性血液透析患者继发性甲状旁腺功能亢进(SHPT)的治疗作用。方法回顾性分析中国医科大学附属第一医院血液净化中心2011—2015年收治的患严重SHPT的20例维持性血液透析患者,按是否手术分为手术组和非手术组,每组各10例。观察手术组术后第1、3、7、14、21天时全段甲状旁腺激素(i PTH)、Ca、P值,以及两组治疗前及治疗后第1、3、6、12个月时血i PTH、Ca、P、RBC、Hb、血细胞压积(HCT)值和治疗前及治疗后1年铁蛋白、转铁蛋白饱和度及铁剂、促红素用量。评估所有患者有无骨痛、行走困难、骨折、身高缩短、尿毒症瘤样钙化、胸闷等临床表现,以及经手术或药物治疗后症状有无缓解。结果手术组术后临床症状明显缓解,i PTH、Ca、P较术前明显下降,且较同期非手术组明显下降(P<0.05);Hb、HCT、RBC水平较术前无明显变化,与同期非手术组相比差异无统计学意义(P>0.05)。手术组术后1年铁蛋白较术前提升,与非手术组治疗后1年铁蛋白相比差异有统计学意义(P<0.05);手术组转铁蛋白饱和度、促红素及铁剂用量手术前后差异无统计学意义,与非手术组同期相比差异无统计学意义(P>0.05)。结论甲状旁腺切除加自体前臂移植术可有效降低i PTH、Ca、P水平,改善继发性甲状旁腺功能亢进患者临床症状。Objective To evaluate the effect of total parathyroidectomy （PTX） and forearm autotransplantation （FAT） to maintenance hemodialysis patients with secondary hyperparathyroidism （SHPT）. Methods We conducted a retrospective study of patients on maintenance hemodialysis with severe SHPT in the First Affiliated Hospital of China Medical University Dialysis Center .They were divided into two groups： ten patients who underwent PTX＋ FAT were enrolled in operation group and others were in non-operation group. For operation group, the intact parathyroid hormone （iPTH）, calcium（Ca） and phosphorus（P） were observed 1,3,7,14,21 days after PTX＋FAT. The iPTH, Ca, P, RBC, Hb ,HCT were assessed before and 1, 3, 6, 12 months after treatment, for all the patients. The ferritin, transferrin saturation level and dose of ferralia and recombinant human erythropoietin（rhEPO） requirement were assessed before and one year after treatment for all the patients. Clinical manifestation such as the bone pain, experience difficulty in walking, fracture, height shortening ,uremic tumoral calcinosis（UTC）, chest distress ,were observed before and after the treatment. Results The clinical symptoms were got remission after PTX＋FAT in operation group .The iPTH ,Ca and P level showed a significant decrease after PTX＋FAT in operation group and also showed a significant decrease compared to the non-operation group（P〈0.05）. Hb, RBC and HCT showed no significant differences in before and after PTX＋FAT ,and also showed no significant differences at the same time compared to the non-operation group（P〉0.05）. No significant differences were found before and after PTX＋FAT in transferrin saturation ,rhEPO and ferralia dose requirement in operation group（P^0.05）,but the ferritin showed a significant differences after PTX＋FAT （P〈0.05）. Conclusion PTX＋FAT can effectively reduce the iPTH, Ca and P levels, improve clinical symptoms in maintenance hemodialysis patients with secondary hyperparathyr

关 键 词：继发性甲状旁腺功能亢进 维持性血液透析 甲状旁腺切除 自体前臂移植 

分 类 号：R582.1[医药卫生—内分泌]