不同方法治疗继发性甲旁亢对血透患者肾性贫血的影响  

Effects of different methods of treatment for secondary hyperparathyroidism on renal anemia in patients receiving hemodialysis

作　　者：李霞[1] 程悦[1] 付永刚[1] 王霞[1] 朱军[1] 郑宇[1] 

机构地区：[1]成都军区总医院肾内科,成都610083

出　　处：《西南国防医药》2015年第10期1072-1075,共4页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的观察维持性血液透析患者合并继发性甲状旁腺功能亢进（SHPT）在接受3种不同方法治疗后,其肾性贫血的改善情况。方法 （1）回顾2013年1月-2014年1月在我院行维持性血液透析治疗患者共126例,观察不同甲状旁腺素（i PTH）水平患者血红蛋白达标率的差异。（2）回顾分析70例i PTH〉300 pg/ml的SHPT患者,观察3种不同的治疗方法 （骨化三醇冲击治疗46例、骨化三醇冲击加口服磷结合剂17例、甲状旁腺全切加自体前臂移植术7例）对患者i PTH、Hb、HCT及EPO用量的影响。结果 （1）不同i PTH水平的患者Hb达标率存在差异,其中i PTH〉300 pg/ml的患者Hb达标率最低;（2）3种不同的治疗方法均能降低i PTH水平,有效升高Hb和HCT,并减少EPO用量。其中甲状旁腺全切加自体前臂移植术在升高血红蛋白、减少EPO用量方面优于另外两种疗法,但差异尚无统计学意义（P〉0.05）。结论 SHPT参与了维持性透析患者肾性贫血的发生,治疗SHPT有助于肾性贫血的纠正;3种不同的方法均能改善肾性贫血,其中以甲状旁腺全切加自体前臂移植术效果最显著。Objective To observe the improvement of renal anemia in patients receiving hemodialysis after three methods of treatment on their secondary hyperparathyroidism（SHPT）. Methods（1） A retrospective review was made in 126 cases receiving hemodialysis in our hospital between January 2013 and January 2014. Observation was made in the differences in the rate of hemoglobin reaching the standard in patients with different i PTH levels.（2） A retrospectively analysis was made in 70 SHPT patients with i PTH〉 300 pg/ml. Observation was made in the influence of three treatment methods（46 patients treated by impulsing with calcitriol; 17 ones treated by impulsing with calcitriol plus oral administration with phosphate binder; and 7 patients received parathyroidectomy plus forearm autograft） on the dosage of i PTH, Hb, HCT, and EPO. Results（1） There were differences in the rate of hemoglobin reaching the standard in patients with different i PTH levels. The rate was the lowest in patients with i PTH300 pg/ml.（2） The three treatment methods all could decrease the i PTH level, effectively increase Hb and HCT, and decrease the dosage of EPO.Parathyroidectomy plus forearm autograft was superior to the other two methods in increasing hemoglobin and decreasing the dosage of EPO, but the differences were not significant（P〉 0.05）. Conclusion SHPT takes part in the occurrence of renal anemia in patients receiving hemodialysis. The treatment of SHPT would be beneficial to the improvement of anemia. The treatment on SHPT can help to rectify renal anemia. The three methods all can improve renal anemia, in which parathyroidectomy plus forearm autograft has the most significant effects.

关 键 词：血液透析 甲状旁腺 功能亢进 肾性贫血 自体移植 

分 类 号：R582.1[医药卫生—内分泌]