肾性甲状旁腺功能亢进患者甲状旁腺切除术中血浆不同甲状旁腺激素片段的变化特点  

Characteristics of intraoperative plasma levels of different parathyroid hormone fragments in renal hyperparathyroidism patients with parathyroidectomy

作　　者：陈慧敏[1] 许雪强[1] 王宁宁[1] 查小明[2] 潘世扬 张丽娜[1] 曾鸣[1] 杨光[1] 俞香宝[1] 孙彬[1] 毛慧娟[1] 张波[1] 欧阳春[1] 任海滨[1] 袁杨刚[1] 张燕 邢昌赢[1] Chen Huimin Xu Xueqiang Wang Ningning Zha Xiaoming Pan Shiyang Zhang Lina Zeng Ming Yang Guang Yu Xiangbao Sun Bin Mao Huijuan Zhang Bo Ouyang Chun Ren Haibin Yuan Yanggang Zhang Yan Xing Changying(Department of Nephrology Department of General Surgery Department of Laboratory Medicine,the First Affiliated Hospital of NJMU, Nanjing 210029, China)

机构地区：[1]南京医科大学第一附属医院肾内科,江苏南京210029 [2]南京医科大学第一附属医院普外科,江苏南京210029 [3]南京医科大学第一附属医院检验学部,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2016年第12期1450-1455,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金(81270408;81570666);中华医学会临床科研专项基金首届肾脏病青年研究基金(13030300415);江苏省"医学重点人才"项目(RC201162);江苏省"六大人才高峰"资助课题(2010-WS-026);江苏省肾脏病临床研究项目(BL2014080)

摘　　要：目的 ：全段甲状旁腺激素（iPTH）是目前临床普遍开展的第2代PTH水平的检测方法 ,同时识别全长（1-84）PTH及（7-84）PTH片段,而第3代PTH（w PTH）检测法可特异性识别（1-84）PTH片段,因而受到临床的重视。本文旨在以慢性肾脏病伴严重继发性甲状旁腺功能亢进（SHPT）行甲状旁腺切除术（PTX）的患者为研究对象,探索其在术中不同PTH片段水平的变化特点。方法：记录58例在本院行PTX的患者术中血浆不同PTH片段的值。分别通过2代和3代PTH检测法测量患者血浆iPTH和（1-84）PTH的水平,（7-84）PTH水平为血iPTH和（1-84）PTH水平的差值。结果：不同PTH片段在术前基线,腺体切除后10、20 min时均两两显著正相关（P〈0.001）。甲状旁腺切除后10 min,血iPTH、（1-84）PTH、（7-84）PTH水平分别降至术前的（19.3±9.5）%、（12.7±8.1）%、（26.7±12.1）%,术后20 min进一步降至（14.1±5.9）%、（7.9±4.4）%、（20.9±8.5）%。结论：2代和3代PTH检测法具有较好的相关性。PTX可显著降低严重SHPT患者血浆不同PTH片段的水平,以血（1-84）PTH下降最为快速。Objective：The second generation intact parathyroid hormone（iPTH） assay is the most widely used method for the measurement of PTH which detect both full-length（1-84）PTH and（7-84）PTH. Whereas,the third generation whole PTH（w PTH）assay has been demonstrated to be specific for the measurement of（1-84）PTH with high attention from the clinic. This research was aimed to explore the features of intraoperative levels of plasma iPTH,（1-84）PTH,（7-84）PTH in chronic kidney disease complicated with secondary hyperparathyroidism（SHPT） patients with parathyroidectomy（PTX）. Methods：Intraoperative levels of plasma iPTH,（1-84）PTH,（7-84）PTH in 58 severe SHPT patients who received total PTX＋autotransplantation were recorded. Plasma iPTH and（1-84）PTH levels were measured by the second and third generation assays,respectively. Circulating（7-84）PTH levels were calculated by subtracting the（1 -4）PTH values from the iPTH values. Results：Plasma iPTH,（1 -84）PTH,（7 -84）PTH levels were closely associated with each other（P 〈 0.001） at baseline,10 and 20 minutes after removing the last parathyroid gland. After PTX,plasma levels of iPTH,（1-84）PTH,（7-84）PTH had dropped to（19.3 ± 9.5）%,（12.7 ± 8.1）%,（26.7 ± 12.1）%,respectively at 10 minutes,（14.1± 5.9）%,（7.9 ± 4.4）%,（20.9 ± 8.5）% at 20 minutes respeatively. Conclusion：The third generation PTH assays were closely correlated with the second generation assays. PTX can significantly abate the levels of plasma different PTH fragments in severe SHPT patients,and intraoperative concentration of plasma（1-84）PTH was decreased more rapidly than iPTH and（7-84）PTH.

关 键 词：肾性甲状旁腺功能亢进 甲状旁腺切除术 全段甲状旁腺激素 全长(1~84)甲状旁腺激素 (7~84)甲状旁腺激素片段 

分 类 号：R582.1[医药卫生—内分泌]