继发性甲状旁腺功能亢进患者手术治疗预后评估的Meta分析  

Meta analysis of the prognostic evaluation of surgical treatment for secondary hyperparathyroidism

作　　者：谢德敏 曲悦 王顺[1] 戴晨[1] 李素华[1] 刘健[1] XIE Demin;QU Yue;WANG Shun;DAI Chen;LI Suhua;LIU Jian(Department of Nephropathy,The First Affiliated Hospital,Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院肾病科,乌鲁木齐830054

出　　处：《新疆医科大学学报》2018年第2期147-152,共6页Journal of Xinjiang Medical University

基　　金：国家科技支撑计划项目(2015BAI12B05)

摘　　要：目的了解继发性甲状旁腺功能亢进(SHPT)患者手术治疗的有效性及预后,为终末期肾脏病(ESRD)患者SHPT的治疗提供临床依据。方法计算机检索PubMed、Web of Science、CNKI、万方、维普、超星等数据库,检索的时间从数据库建立至2016年10月,同时检索与之相关的文献,纳入甲状旁腺切除术(PTX)治疗SHPT患者的随机对照研究、队列研究,并对文献质量进行评价,应用RevMan 5.3软件对资料进行Meta分析。结果检索出402篇文献,最终有9篇纳入该研究,其中甲状旁腺全切除术(TPTX)223人,甲状旁腺全切除术+自体移植术(TPTX+AT)690人;2组在症状改善、持续甲状旁腺功能亢进、全因死亡方面比较差异无统计学意义;2组术后均有复发,复发率分别为:TPTX+AT组11.81%,TPTX组2.24%,差异具有统计学意义(P<0.000 01),TPTX组术后复发率更低;2种术式复发后需要再次手术率的比较差异有统计学意义(P<0.05),TPTX+AT需要再手术的比率(3.73%)更高。结论在复发及再手术方面TPTX组较TPTX+AT组发生率低,但在终点事件心血管死亡方面2种手术方式无明显差别。ObjectiveTo understand the effectiveness of surgical treatment and prognosis of patients with end-stage renal failure(ESRD),and to provide a clinical basis of secondary hyperparathyroidism(SHPT)treatment for ESRD.MethodsRelated literature from PubMed,Web of Science,CNKI,VIP,Wanfang,Chinese superstar etc.were collected,the retrieval time was set up from past to October 2016,including randomized controlled study,study of surgical treatment of patients with ESRD SHPT control study,andthe quality of literature was evaluated,and Meta-analysis of the data was carried by Rev Man 5.3 software.ResultsA total of 402 articles were retrieved,and finally 9 articles were included in this study,including 223 patients with total resection of parathyroid(TPTX),690 patients with total resection of parathyroid(TPTX+AT).Comparison between the two groups in the improvement of symptoms,persistent hyperparathyroidism,all-cause mortality showed no significant difference.Both groups had postoperative recurrence,the recurrence rate was 11.81%and 2.24%in TPTX+AT and TPTX,respectively.The difference between both groups was statistically significant(P<0.000 01).The recurrence rate was lower in group TPTX,and reoperation was needed after recurrence(P<0.05).TPTX+AT had a higher chance of reoperation(3.73%).ConclusionThe incidence of TPTX in relapse and reoperation was lower than that of TPTX+AT,but there was no significant difference between the two methods of cardiovascular death in the end event.

关 键 词：终末期肾衰竭 继发性甲状旁腺功能亢进 甲状旁腺切除术 预后 

分 类 号：R473.6[医药卫生—护理学]