甲状旁腺切除联合自体移植对尿毒症继发性甲状旁腺功能亢进患者左心室肥厚及血清Fetuin-A的影响  

Effect of total parathyroidectomy with auto-transplantation on left ventricular hypertroply and Fetuin-A of SHPT uremiu patients

作　　者：张曼丽 李卫东 Man-li Zhang;Wei-dong Li(Department of Thyroid Breast Surgery,Cangzhou People's Hospital,Cangzhou,Hebei 061000,China)

机构地区：[1]河北省沧州市人民医院甲状腺乳腺外科,河北沧州061000

出　　处：《中国现代医学杂志》2018年第36期58-63,共6页China Journal of Modern Medicine

基　　金：河北省科技计划项目(No:JB0015277792D)

摘　　要：目的研究甲状旁腺切除联合自体移植(tPTX+AT)对继发性甲状旁腺功能亢进(SHPT)尿毒症患者的疗效及对左心室肥厚、血清胎球蛋白A(Fetuin-A)、炎症因子的影响。方法 74例SHPT尿毒症患者被随机分为两组,每组37例。对照组行常规治疗,观察组在此基础上行t PTX+AT术。术后6个月比较两组患者甲状旁腺激素(i PTH)、血清钙、磷浓度变化,采用超声心动图检测左心室肥厚的指标变化情况,检测治疗前后血清Fetuin-A、超敏C-反应蛋白(hs-CRP)水平及白细胞介素6(IL-6)水平。结果术后6个月随访,观察组的血清钙、血清磷、钙磷乘积以及i PTH均下降(P <0.05),对照组上述指标变化差异无统计学意义(P>0.05)。观察组舒张末期室间隔厚度(IVST)、左心室重量指数(LVMI)、左心室后壁厚度(LVPWT)均下降,左心室射血分数(LVEF)升高(P <0.05);钙化率变化差异无统计学意义(P>0.05)。对照组的IVST、LVMI、LVPWT变化差异无统计学意义(P>0.05);但钙化率升高(P <0.05)。观察组Fetuin-A升高,hs-CRP和IL-6水平下降(P <0.05);对照组变化差异无统计学意义(P>0.05)。结论 tPTX+AT术能有效降低SHPT尿毒症患者的血磷、血钙和i PTH浓度,改善临床症状及患者的左心室肥厚,延缓心脏瓣膜钙化进展,同时上调Fetuin-A浓度,下调IL-6和hs-CRP浓度。Objective To analyze the effect of total parathyroidectomy with autologous transplantation(tPTX+AT)in the treatment of secondary hyperparathyroidism(SHPT)uremia patients and influence on left ventricular hypertrophy and Fetuin-A.Methods Totally 74 SHPT uremia patients were involved in this study,and were randomly divided into control group and observation group(n=37).All patients were treated with standard therapy while patients in observation group received additional treatment of tPTX+AT.iPTH,serum concentration of calcium and phosphorus,Fetuin-A,IL-6 and hs-CRP were measured.Left ventricle was evaluated by echocardiographic test.Results Levels of iPTH,serum calcium and phosphorus,calcium-phosphorus product,hs-CRP and IL-6 in observation group were decreased and levels of fetuin-A were increased significantly(P<0.05),while those in control group did not show any obvious change(P>0.05).The IVST,LVMI and LVPWT in patients of observation group decreased while LVEF was increased dramatically(P<0.05).However,no alteration in IVST,LVMI,and LVPWT in control group was witnessed(P<0.05).Calcification rate did not show any change in observation group while that was increased obviously in control group.Conclusions tPTX+AT can improve the clinical symptoms,and delay the progression of cardiac valve calcification in patients with SHPT uremia.

关 键 词：甲状旁腺切除术 移植 自体 继发性甲状旁腺功能亢进 尿毒症 左心室肥厚 胎球蛋白A 

分 类 号：R581[医药卫生—内分泌]