甲状旁腺切除术对血液透析患者冠状动脉钙化进展的影响  

Impact of parathyroidectomy on the progression of coronary artery calcification in maintenance hemodialysis patients

作　　者：阚森 张倩[1] 王梦婧[1] 丁旻雯 张敏敏[1] 黄碧红[1] 袁立[1] 陈靖[1] 

机构地区：[1]复旦大学附属华山医院肾脏科,上海200040

出　　处：《中国血液净化》2015年第7期408-411,共4页Chinese Journal of Blood Purification

基　　金：国家自然科学基金(81170684;81400745);上海市科技英才扬帆计划(14YF1400900)

摘　　要：目的观察甲状旁腺切除术(parathyroidectomy,PTX)对伴有继发性甲状旁腺功能亢进症(Secondary Hyperparathyroidism,SHPT)的血液透析患者冠状动脉钙化(Coronary artery calcification,CAC)进展的影响,并分析CAC进展的相关因素。方法 37例维持性血液透析(maintenance hemodialysis,MHD)患者,其中9例因难治性SHPT行甲状旁腺切除术,另外28例未做手术。基线以及随访时均应用多层螺旋CT检测CAC积分,比较2组CAC积分进展情况以及血钙、血磷、i PTH等指标,采用单因素和多因素回归分析CAC进展和临床参数的相关性。结果手术组患者随访血钙、血磷、i PTH水平分别为(2.1±0.3)mmol/L、(1.3±0.5)mmol/L和(82.1±96.6)mmol/L,较基线(2.5±0.4)mmol/L、(1.8±0.4)mmol/L和(846.6±588.4)mmol/L均明显降低,差异有统计学意义(P均<0.05)。与基线CAC积分比较,患者随访CAC积分有明显升高,但2组患者CAC进展速度(128.9±169.9)分/年和(137.5±143.3)分/年无显著性差异;单因素与多因素回归分析显示CAC进展与i PTH水平改变、平均血钙磷水平等均无相关性,与糖尿病和基线CAC积分水平存在相关性(P分别为0.002和0.001)。结论甲状旁腺切除术可以显著改善血液透析患者的钙磷代谢紊乱,但并未改善CAC进展情况,糖尿病和基线CAC积分可能影响CAC的进展。Objective To observe the impact of parathyroidectomy（PTX） on the progression of coronary artery calcification（CAC） in maintenance hemodialysis（MHD） patients complicated with secondary hyperparathyroidism（SHPT）, and to analyze the factors contributing to the progression of CAC. Methods A total of 37 MHD patients were enrolled in this study. Nine of them underwent PTX due to refractory SHPT,and 28 of them without PTX were used as controls. Computed tomographic imaging was performed at baseline and in follow-up period to obtain the changes of CAC score. CAC score, serum calcium, phosphorus and i PTH at baseline and in follow-up period were compared between the two groups. Results In PTX group,serum calcium, phosphorus and i PTH at follow-up period after PTX were 2.1±0.3 mmol/L, 1.3±0.5 mmol/L and 82.1 ± 92.6 mmol/L, respectively, significantly lower than those at baseline（P〈0.05）. The general CAC score in follow-up period increased significantly, but the annualized change of CAC score was indifferent between the two groups. Progression of CAC was significantly associated with diabetes and baseline CAC score（P=0.0002 and 0.0001, respectively）, but not with serum i PTH. Conclusions PTX improved calcium and phosphorus metabolism, but had no effect on the progression of CAC in MHD patients with SHPT. Diabetes and baseline CAC score may affect the progression of CAC.

关 键 词：血液透析 继发性甲状旁腺功能亢进 甲状旁腺切除术 冠状动脉钙化积分 

分 类 号：R318.16[医药卫生—生物医学工程]