甲状旁腺切除术对继发性甲状旁腺功能亢进患者肾性贫血及营养状况的影响  

Effect of parathyroidectomy on renal anemia and nutritional status in patients with secondary hyperparathyroidism

作　　者：刘道同[1] 郭猛[1] 徐静[1] 

机构地区：[1]山东省济宁市第一人民医院乳腺甲状腺外科,272000

出　　处：《中国医药》2015年第8期1145-1149,共5页China Medicine

摘　　要：目的 探讨甲状旁腺切除术（PTX）对继发性甲状旁腺功能亢进（SHPT）患者肾性贫血及营养状况的影响.方法 收集2012年3月至2013年12月于山东省济宁市第一人民医院乳腺甲状腺外科行PTX治疗的SHPT患者40例,随访期12个月.观察治疗前、治疗后第1、6、12个月时全段甲状旁腺激素（iPTH）、血清钙、血磷、钙磷乘积、血红蛋白、血细胞比容（Hct）指标,同期重组人红细胞生成素（rHuEPO）用量,血清白蛋白、总胆固醇、三酰甘油、血清铁、铁蛋白、C反应蛋白（CRP）、透析充分性[尿素清除指数（Kt/V）、尿素下降率（URR％）]、肱三头肌皮褶厚度（TSF）、上臂肌围及体重指数指标变化,并记录数据.结果 患者术后第1、6和12个月血清iPTH水平较术前明显下降,差异有统计学意义[（472 ±98）、（445±95）、（422±93） ng/L比（2 273±275）ng/L] （P＜0.01）;高钙高磷症状得到明显改善,术后第1、6和12个月血清钙、血磷及钙磷乘积水平明显下降,与术前比较差异有统计学意义[钙磷乘积：（2.4±1.0）、（2.5±1.0）、（2.6±1.2）比（6.4±2.0）]（P＜0.01）;贫血逐步改善,术后第1、6、12个月血红蛋白水平与术前比较差异有统计学意义（P ＜0.01）;rHuEPO用量术后逐步减少,术后第6和12个月用量明显减少,与术前比较差异有统计学意义（P＜0.05和P＜0.01）.营养状况逐步改善,术后第1个月血清白蛋白水平较术前普遍轻度下降,术后第6和12个月升高,与术前比较差异有统计学意义（P＜0.05和P＜0.01）;术后第12个月三酰甘油明显下降,与术前比较差异有统计学意义（P＜0.01）;术后第12个月体重指数、TSF水平明显升高,与术前比较差异有统计学意义（P＜0.01）.结论 PTX手术治疗可迅速降低SHPT患者iPTH水平并明显改善肾性贫血及营养状况;SHPT是影响肾性贫血及营养不良的重要因素.Objective To investigate the effect of parathyroidectomy （PTX） on renal anemia and nutritional status in patients with secondary hyperparathyroidism （SHPT）.Methods Totally 40 SHPT patients receiving PTX from March 2012 to December 2013 were followed-up for 12 months.The parathyroid hormone （iPTH）,serum calcium,serum phosphorus,calcium phosphorus product,hemoglobin,hematocrit （HCT）,recombinant human erythropoietin （rHuEPO） dosage,serum albumin,total cholesterol,triglyceride,serum iron,ferritin,C-reactive protein （CRP）,dialysis adequacy [urea clearance index （Kt/V）,urea reduction ratio （URR%）],triceps skinfold thickness （TSF）,changes of upper arm muscle circumference and weight index were measured before treatment,1,6 and 12 months after operation.Results The levels of serumi PTH,calcium,phosphorus,calcium phosphorus product began to decreased from the first month to the twelfth month after operation than before operation[（472 ± 98）,（445 ± 95）,（422 ± 93） ng/L vs （2 273 ± 275） ng/L,（2.4±1.0）,（2.5±1.0）,（2.6±1.2） vs （6.4±2.0）]（P〈0.01）.The anemia was gradually improved from the first month after operation with hemoglobin and HCT significantly increasing at 6 months and 12 months after operation（P 〈 0.01）.The dosage of rHuEPO was decreased gradually and was significantly decreased 6 and 12 months after operation （P 〈 0.01）.The nutritional status was gradually improved since 6 months after operation with serum albumin being significantly higher 6 and 12 months after operation compared with that before operation （P 〈 0.05 or P 〈 0.01）.The triglyceride was significantly decreased 12 months after operation;the body mess index and TSF were significantly increased 6 months after operation （P 〈 0.01）.Conclusion PTX can quickly reduce the level of iPTH;it can significantly improve renal anemia andnutritional status in patients withSHPT.

关 键 词：继发性甲状旁腺功能亢进 甲状旁腺激素 甲状旁腺切除术 肾性贫血 营养状况 

分 类 号：R582.1[医药卫生—内分泌]