难治性继发性甲状旁腺功能亢进患者角膜和结膜钙化的观察及分析  

Clinical Observation and Analysis of Corneal and Conjunctival Calcification in Patients with Refractory Secondary Hyperthyroidism

作　　者：曾红梅[1,2] 张凌[3] 刘柳华[4] 张仲臣[5] 于海涛[6] 王艺萍[2] 蒋金玉[2] 肖跃飞[2] 

机构地区：[1]锦州医科大学,锦州121001 [2]航天中心医院(北京大学航天临床医学院)肾内科,北京研究生100049 [3]中日友好医院肾内科,北京100029 [4]航天中心医院(北京大学航天临床医学院)超声科,北京100049 [5]航天中心医院(北京大学航天临床医学院)眼科,北京100049 [6]航天中心医院(北京大学航天临床医学院)放射科,北京100049

出　　处：《中国血液净化》2016年第5期275-279,共5页Chinese Journal of Blood Purification

基　　金：北京市科委首都特色临床医学应用发展资助项目(Z15110700400000)

摘　　要：目的探讨难治性继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)患者角膜和结膜钙化与血管钙化之间的关系。方法用裂隙灯检查角膜和结膜钙化(conjunctival and corneal calcification,CCC)的情况并量化评分,采用腹部侧位X线平片评判患者腹主动脉钙化(abdominal aortic calcification,AAC)情况,心脏彩超评估心脏瓣膜钙化(cardiac valve calcification,CVC)。Spearman相关性分析CCC与CVC、AAC之间的相关性,用单因素方差分析方法分析难治性SHPT患者不同CCC评分分组的可能影响因素。结果①共入选43例难治性SHPT患者,平均年龄(49.51±9.66)岁,中位透析龄96(12,204)月。CVC和CCC评分之间的Spearman等级相关系数为(r=0.321,P=0.036),AAC和CCC评分之间的Spearman等级相关系数为(r=0.337,P=0.027)。②AAC<5分组与AAC≥5分组患者在年龄(t=-2.258,P=0.029)、吸烟史(t=-2.332,P=0.025)、CVC评分(t=-2.835,P=0.007)之间的差异也具有统计学意义;CVC≤1分组与CVC>1分组患者在年龄(t=-2.283,P=0.028)、透析龄(t=-2.235,P=0.023)、血磷(t=2.927,P=0.006)、尿素(t=2.330,P=0.025)、尿酸(t=2.541,P=0.015)、血高密度脂蛋白(t=-2.634,P=0.012)、AAC评分(t=-2.595,P=0.013)之间的差异存在统计学意义。③CCC不同评分分组间单因素方差分析结果提示透析龄(F=4.772,P=0.014),吸烟史(F=3.334,P=0.046),AAC评分(F=6.803,P=0.003),CVC评分(F=6.227,P=0.004)存在显著差异。结论难治性SHPT患者普遍存在角膜和结膜钙化,CCC与AAC、CVC间呈正相关关系,腹主动脉钙化、心脏瓣膜钙化越重,透析时间越长,发生角膜和结膜钙化的风险也越高。Objective To observe the condition of conjunctival and corneal calcification refractory sec- ondary hyperparathyroidism （SHPT） patients, and explore the relationship between conjunctival and corneal calcification （CCC）, abdominal aortic calcification （AAC） and cardiac valve calcification （CVC）. Methods CCC was evaluated by slitlamp eye photographs, and was graded and scored according to Porter＇ S classifica- tion system in the literature. Abdominal lateral X-ray examination were used as criteria to determine the AAC ~ The AAC score was calculated. Echocardiographic was applied evaluate CVC. Spearman correlation coef- ficient was used to analyze the relationship between CCC and AAC, CVC. Single factor analysis of variance was used to determine the influence factor of CCC in refractory SHPT patients. Results Forty-three refrac- tory SHPT patients were recruited. Their average age were （49.51±9.66） years and dialysis age were 96 （12, 204） months. The CCC was positively correlated with AAC （r=0.337, P〈0.05）, the CCC was positively cor-related with CVC （r=0.321, P〈0.05）. As for age （t=-2.258, P=0.029）, smoking history （t=-2.332, P=0.025） and CVC score （t=-2.835, P=0.007）, there were statistically significant difference between the patients in AAC〈5 group and AAC acuity group （all P〈0.05）;There was statistically significant difference between the CVC score 〈 1 group and CVC〉 1 group in age （t=-2.283, P=-0.028）, dialysis age （t=-2.235, P=0.023）, blood phosphorus （t=2.927, P=0.006）, urea （t=2.330, P=-0.025）, uric acid （t=-2.541, P=0.015）, blood HDL （t=-2.634, P=0.012）, and AAC score （t=-2.595, P=0.013）. Single factor analysis of variance showed that the score of AAC （F=6.803, P=0. 003）, CVC （F=6.227, P=0.004）, Smoking history （F=3.334,P=-0.046） and Dialysis age （F=4.772, P=0.014） were significant impact on CCC. Conclusions Coniunctival and corneal calcification is common in refractory SHPT patients, and CCC is posit

关 键 词：难治性继发性甲状旁腺功能亢进 角膜和结膜钙化 腹主动脉钙化 心脏瓣膜钙化 

分 类 号：R318.16[医药卫生—生物医学工程]