甲状旁腺切除术对维持性血液透析患者营养状态的影响  

Effect of parathyroidectomy on nutritional status in patients with maintenance hemodialysis

作　　者：陈玉 何建强[2] 徐三荣[2] 朱承松 邓先仁 Chen Yu;He Jianqiang;Xu Sanrong;et al.(Department of Nephrology, Zhenjiang Hospital of Chinese Traditional and Western Medicine, Zhenfiang 212002, China)

机构地区：[1]江苏省镇江市中西医结合医院,212002 [2]江苏大学附属医院

出　　处：《临床内科杂志》2018年第6期399-401,共3页Journal of Clinical Internal Medicine

摘　　要：目的观察维持性血液透析患者继发甲状旁腺功能亢进症（SHPT）行甲状旁腺切除术（PTX）后营养状态的改变。方法选取28例维持性血液透析SHPT经内科保守治疗无效、行PTX的患者，观察其手术前及手术1年后血清甲状旁腺激素（PTH）、钙、磷、血红蛋白（Hb）、白蛋白（A1b）、总胆固醇（Tc）、甘油三酯（TG）、体表测量肱三头肌皮褶厚度（TSF）、上臂围（MAC）的变化，计算上臂肌围（MAMC）、体重指数（BMI），应用改良主观全面营养评价法（SGA）对患者进行营养评估。结果PTX治疗1年后患者SGA评分、血清钙、磷、PTH及TG较手术前明显下降，TSF、MAMC、BMI、Hb及A1b较手术前明显升高，差异均有统计学意义（P〈0．05或P〈0．01），而TC较手术前无明显变化（P〉0．05）。结论PTX手术治疗能有效改善经内科保守治疗无效的维持性血液透析SHPT患者的营养状态，同时SHPT是维持性血液透析SHPT患者营养不良的重要因素。Objective To observe the changes of nutritional status after parathyroidectomy （PTX） in patients of maintenance hemodialysis with secondary hyperparathyroidism （SHPT）. Methods Twenty-eight patients of maintenance hemodialysis with SHPT who underwent ineffective conservative medical treatment and PTX were selected. The changes of serum parathyroid hormone （PTH）, calcium, phosphorus, hemoglobin （ Hb）, albumin （ Alb ）, total cholesterol （ TC ）, triglyceride （ TG ）, triceps skin fold thickness （TSF） and Upper arm circumference （ MAC ） were observed before and 1 year after operation. The upper arm muscle circumference （MAMC） and body mass index （BMI） were calculated. Improved subjective comprehensive nutrition evaluation（SGA） and other methods were used to assess the patients＇ nutrition. Results SGA score, serum calcium, phosphorus, PTH and TG of 1 year after PTX therapy decreased significantly compared with that before surgery, while TSF, MAMC, BMI, Hb and Alb were significantly higher than those before surgery（P 〈0.05 or P 〈0.01 ） ,but TC was not significantly different from that before surgery（P 〉 0.05 ）. Conclusion PTX can effectively improve the nutritional status of patients with maintenance hemodialysis and SHPT who undergo ineffective conservative medical treatment. SHPT is a major factor for poor nutrition in patients of maintenance hemodialysis with SHPT at the same time.

关 键 词：维持性血液透析 甲状旁腺功能亢进症 甲状旁腺切除术 营养状态 

分 类 号：R459.5[医药卫生—治疗学]