甲状旁腺全切除加前臂自体移植术对继发性甲状旁腺功能亢进症患者左心室肥厚的影响  

Effect of parathyroidectomy combined with autograft in forearm on left ventricular hypertrophy in uremic patients with secondary hyperparathyroidism

作　　者：侯爱珍[1] 肖观清[1] 张豫[1] 陈囿元 张剑利[2] 孔耀中[1] HOU Ai-zhen XIAO Guan-Qing ZHANG Yu CHEN You-yuan ZHANG Jian-li KONG Yao-zhong(Department of Nephrology Department of ENT, Foshan First Hospital （Foshan Hospital Affiliated to Sun Yet-sen University）, Foshan 528000, China)

机构地区：[1]佛山市第一人民医院(中山大学附属佛山医院)肾内科,广州528000 [2]佛山市第一人民医院(中山大学附属佛山医院)耳鼻喉科,广州528000

出　　处：《中国血液净化》2017年第1期39-43,共5页Chinese Journal of Blood Purification

摘　　要：目的观察甲状旁腺全切除加自体前臂移植术(total parathyroidectomy with autotransplantation,t PTX+AT)对尿毒症合并继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)患者左心室肥厚的影响。方法选取28例SHPT患者,分为手术组(n=13)和非手术组(n=15),2组治疗前、后6月检查血清全段甲状旁腺激素(intact parathyroid hormone,i PTH)、血清钙(calcium,Ca)、血清磷(phosphorus,P)等水平,心脏超声检查左室舒张末期内径(left ventricular end diastolic diameter,LVDd),室间隔厚度(interventricular septal thickness,IVST)、左室后壁厚度(left ventricular posterior wall thickness,LVPWT)、计算左心室质量指数(left ventricular mass index,LVMI),并记录每例患者心脏瓣膜钙化的瓣膜数,计算每组患者瓣膜钙化率(钙化的瓣膜数/总瓣膜数)等。结果 6月后,术组患者血清i PTH(t=129.592,P<0.001)、Ca(t=4.318,P=0.049)、血磷(t=16.997,P<0.001)水平均较术前明显降低,LVMI由(169.21±51.58)g/m^2下降到(118.67±42.52)g/m^2,手术治疗对左心室质量指数的影响具有统计学意义(t=8.026,P=0.049),瓣膜钙化人数术前/术后为9/7人,钙化的瓣膜数术前/术后为12/12个;非手术组前后6月血清i PTH、Ca、P水平均无显著降低(均P>0.05),LVMI由(161.85±62.43)g/m^2升至(208.57±74.61)g/m^2,虽无统计学差异(t=0.484,P=0.334),但左心室肥厚有进展趋势,而心脏瓣膜钙化总人数治疗前/后为9/13人,钙化的总瓣膜数治疗前后为11/21个,治疗后瓣膜钙化率较治疗前显著升高(46.67%比24.44%,χ~2=4.849,P=0.028)。结论甲状旁腺切除术能有效改善尿毒症SHPT患者的左心室肥厚,而非手术组患者的心脏瓣膜钙化有加重趋势。Objective To observe the effect of total parathyroidectomy combined with autologous transplantation in forearm（t PTX＋AT） on the left ventricular hypertrophy in uremia patients with secondary hyperparathyroidism（SHPT）. Methods A total of 28 SHPT patients were divided into two groups, operation group（n=13） and non-operation group（n=15）. Before the operation and after the operation for 6 months, serum calcium（Ca）, phosphorus（P）, serum parathyroid hormone（i PTH） levels, left ventricular end diastolic diameter（LVED）, interventricular septum diastolic thickness（IVST）,left ventricular posterior wall diastolic thickness（LVPWT）, left ventricular ejection fraction（LVEF）, and left ventricular mass index（LVMl） were measured.The number of calcified valves in each patient was recorded, and the ratio of calcified valves / total valves（%）in each group was calculated. Results After the operation for 6 months in operation group, serum Ca, P and i PTH levels decreased significantly as compared with the pre- operative values（P〈0.001）, and LVMI decreased from（169.21±51.58）g/m^2 to（118.67±42.52）g/m^2（t=8.026, P=0.049）. The number of patients with valvular calcification decreased from 9 patients to 7 patients, but the number of calcified valves had no change（12 valves）. In non-operation group before and after the regular treatment, serum Ca, P and i PTH levels had no significantly changes（P〈0.05）, LVMI showed the tendency of deterioration and increased from 161.85±62.43g/m^2 to 208.57 ± 74.61 g/m^2 but without statistical significance（t=0.484, P=0.334）. The number of pa-tients with valvular calcification increased from 9 patients to 13 patients, the total number of calcified valves increased from 11 valves to 21 valves, and the ratio of calcified valves / total valves increased significantly（46.67% vs. 24.44%, χ^2=4.849, P=0.028）. Conclusion Parathyroidectomy can effectively improve the left ventricular hypertrophy in uremic patients with SHP

关 键 词：尿毒症 继发性甲状旁腺功能亢进 甲状旁腺切除术 左心室肥厚 心脏瓣膜钙化 

分 类 号：R318.16[医药卫生—生物医学工程]