非糖尿病SHPT血液透析患者行PTX+AT对钙磷代谢和胰岛素分泌的影响  

Effects of parathyroidectomy with autotransplantation on calcium-phosphorus disorder and insulin secretion in non-diabetic uremic patients with SHPT

作　　者：陈亚巍 孙新增[1] 张萍[1] 陶新朝[1] CHEN Ya-wei;SUN Xin-zeng;ZHANG Ping;TAO Xin-chao(Department of Nephrology,Chinese PLA 254th Hospital,Tianj in 300142,China)

机构地区：[1]中国人民解放军第254医院肾脏内科,天津300142

出　　处：《天津医科大学学报》2018年第6期532-535,共4页Journal of Tianjin Medical University

摘　　要：目的:观察非糖尿病维持性血液透析(MHD)患者并发继发性甲状旁腺亢进(SHPT)后行甲状旁腺全切术+前臂移植(PTX+AT)钙磷和糖代谢指标的变化。方法:回顾性分析84例MHD并发SHPT的临床资料,其中52例SHPT患者行PTX+AT手术治疗,32例行药物治疗,观察治疗前后全段甲状旁腺激素(iPTH)、血钙(Ca)、血磷(P)、血碱性磷酸酶(ALP)等指标的变化,以及患者空腹血糖、胰岛素水平变化。结果:PTX+AT术后,患者血Ca、P、iPTH和ALP水平明显降低,术后1周胰岛素水平开始明显升高,差异具有统计学意义(P<0.05);而药物治疗组1个月和3个月血P、iPTH明显降低,但6个月后恢复至治疗前水平,且ALP水平明显增高,血糖和胰岛素水平无显著性变化。结论:PTX+AT是治疗SHPT的有效手段,可明显降低血iPTH水平,调节钙磷代谢紊乱;同时可以增加胰岛素分泌。Objective： To observe the effects of PTX＋AT on calcium-phosphorus disorder and insulin secretion for non-diabetic uremic patients with SHPT. Methods：Eighty-four MHD with SHPT patients were enrolled, and their data were retrospectively analyzed. Fifty-two SHPT patients were treated with PTX＋AT and thirty-two patients were treated with medicine. Serum intact parathyroid hormone （iPTH）, calcium （Ca）, phosphorus （P）,alkaline phosphatase （ALP） and fasting insulin obtained preoperatively and postoperatively were collected and compared. Results： Serum iPTH, Ca, and P decreased significantly in postoperative period （P〈0.05） and fasting insulin began to increase significantly in one week after the operation （P〈0.05）. After one month and three months of medical treatment, the level of iPTH and P decreased significantly.But after six months the effect disappeared, and ALP level increased significantly. The change of fasting glucose and insulin had was not statistically significant. Conclusion： PTX＋AT can effectively decrease iPTH level and regulate the calcium- phosphorus disorder, so it is an effective operation for uremic patients with SHPT. It can also promote the secretion of insulin.

关 键 词：维持性血液透析 继发性甲状旁腺功能亢进 甲状旁腺切除术 胰岛素 

分 类 号：R605[医药卫生—外科学]