甲状旁腺切除术治疗终末期血液透析患者SHPT疗效及对肿瘤样钙质沉着、血清FGF23水平的影响  

Effect of parathyroidectomy on SHPT in patients with end-stage hemodialysis and its effect on tumor like calcinosis and serum FGF23 level

作　　者：李玉平[1] 徐海燕[1] 刘翻利[1] 陈琼[1] 姜婷 LI Yuping;XU Haiyan;LIU Fanli;CHEN Qiong;JIANG Ting(Department of Nephrology,Inner Mongolia Bayannaoer Hospital,Inner Mongolia,Bayannaoer 015000,China)

机构地区：[1]内蒙古巴彦淖尔市医院肾内科,015000

出　　处：《疑难病杂志》2018年第11期1229-1232,1237,共5页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的观察甲状旁腺切除术(PTX)治疗终末期血液透析并发继发性甲状旁腺功能亢进(SHPT)患者疗效及对肿瘤样钙质沉着、血清成纤维细胞生长因子23(FGF23)水平的影响。方法选择2016年1月—2017年9月内蒙古巴彦淖尔市医院肾内科收治的终末期血液透析并发SHPT患者106例作为研究对象,按照患者意愿分为手术组(n=75)和非手术组(n=31)。手术组患者给予甲状旁腺切除术,非手术患者给予药物治疗。比较2组患者治疗前以及治疗后6个月的FGF-23、血清骨钙素(OC)、Ⅰ型前胶原氨基末端前肽(PINP)、β胶原蛋白(β-CTX)水平、相关生化指标水平以及骨痛、钙化评分差异,并分析2组患者治疗后的并发症发生情况。结果 2组患者治疗前血钙、血磷、ALP、iPTH、FGF-23水平、骨痛评分、钙化评分以及血清OC、PINP、β-CTX水平比较差异无统计学意义(P> 0. 05)。治疗后2组患者的血钙、血磷、ALP、iPTH、FGF-23水平、骨痛评分、钙化评分以及血清OC、PINP、β-CTX水平均明显下降,且手术组较非手术组下降更显著(t/P=26. 337/0. 000,19. 691/0. 000,66. 320/0. 000,19. 251/0. 000,38. 070/0. 000,14. 257/0. 000,5. 959/0. 000,8. 975/0. 000,10. 910/0. 000,2. 019/0. 019)。2组患者治疗后并发症比较差异无统计学意义(9. 68%vs. 13. 33%,χ~2=0. 463,P=0. 496)。结论甲状旁腺切除术治疗终末期血液透析SHPT患者可以有效的降低血磷、血钙以及骨相关指标水平,减少血清FGF-23水平,降低皮肤瘙痒、肌肉无力等并发症发生情况,改善骨以及相关矿物质的代谢。Objective To investigate the effect of parathyroidectomy(PTX)in patients undergoing end-stage hemodialysis complicated with secondary hyperparathyroidism(SHPT)and its effect on tumor-like calcification and serum FGF23 levels,providing a reference for clinical treatment.Methods We selected 106 patients with end-stage hemodialysis complicated with SHPT who were admitted to the Department of Nephrology,Bayannaoer Hospital,Inner Mongolia from January 2016 to September 2017.Patients were divided into surgery group(n=75)and non-surgical group according to the patients'wishes(n=31),in which patients in the surgical group were treated with parathyroidectomy and nonsurgical patients were given medication.The levels of FGF-23,OCPINP,β-CTX,related biochemical indicators,bone pain,and calcification scores before and after treatment were compared between the two groups,and the complications after treatment were analyzed.Results There were no significant differences in serum calcium,phosphorus,ALP,iPTH,FGF-23 levels,bone pain scores,calcification scores,and serum OC,PINP,andβ-CTX levels before treatment between the two groups(t/P=0.174/0.431,t/P=0.395/0.347,t/P=0.217/0.414,t/P=0.024/0.491,t/P=0.295/0.384,t/P=0.034/0.486,t/P=0.019/0.493,t/P=0.038/0.485,t/P=0.052/0.479,t/P=0.100/0.460).After treatment,serum calcium,phosphorus,ALP,iPTH,FGF-23 levels,bone pain scores,calcification scores,and serum OC,PINP,andβ-CTX levels were significantly higher in the surgery group.The difference was statistically significant(t/P=26.337/0.000,t/P=19.691/0.000,t/P=66.320/0.000,t/P=19.251/0.000,t/P=38.070/0.000,t/P=14.257/0.000,t/P=5.959/0.000,t/P=8.975/〗0.000,t/P=10.910/0.000,t/P=2.019/0.019).In addition,there was no significant difference in postoperative complications between the two groups(P>0.05).Conclusion Parathyroidectomy for the treatment of end-stage hemodialysis SHPT patients can effectively reduce blood phosphorus,serum calcium and bone-related indicators,reduce serum FGF-23 levels,reduce skin pruritus,muscle weakness and other c

关 键 词：甲状旁腺切除术 终末期血液透析 甲状旁腺功能亢进 继发性 成纤维细胞生长因子23 

分 类 号：R692.5[医药卫生—泌尿科学] R582.1[医药卫生—外科学]