甲状旁腺切除对尿毒症继发性甲状旁腺机能亢进症患者生活质量的影响  

Effect of parathyroidectomy resection on the quality of life of hemodialysis patients with secondary hyperparathyroidism

作　　者：侯爱珍[1] 张剑利[2] 周余 叶佩仪[1] 黄雪芳[1] 肖观清[1] 李导 孔耀中[1] Hou Aizhen;Zhang Jianli;Zhou Yu;Ye Peiyi;Huang Xuefang;Xiao Guanqing;Li Dao;Kong Yaozhong(Department of Nephrology,Foshan First,Hospital,Foshan 528000,China)

机构地区：[1]佛山市第一人民医院肾内科,528000 [2]佛山市第一人民医院耳鼻喉科,528000

出　　处：《国际移植与血液净化杂志》2019年第6期16-20,共5页International Journal of Transplantation and Hemopurification

摘　　要：目的探讨甲状旁腺切除术(parathyroidectomy,PTX)对维持性血液透析(maintenance hemodialysis,MHD)合并严重继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)患者生活质量的影响.方法选取2014~2017年在本院行MHD合并严重SHPT的患者,符合入选条件者分成手术组与非手术组,手术组行PTX,非手术组予药物治疗.对比两组治疗前和治疗后12个月的生化指标和简明健康调查问卷(Short Form-36 Health Survey Questionnaire,SF-36)评分.结果共纳入67例患者,手术组37例,非手术组30例.两组年龄、原发病、透析龄、全段甲状旁腺素(intact parathyroid hormone,iPTH)、血钙、血磷、血红蛋白浓度(hemoglobin,HGB)、白蛋白(albumin,Alb)差异均无统计学意义(P>0.05);12个月后手术组血iPTH、血钙、血磷、钙磷乘积水平显著低于非手术组(P<0.05);HGB、血Alb水平两组差异无统计学意义(P>0.05);12个月后手术组SF-36评分除社会功能外,其他七个维度(如生理机能、生理职能、躯体疼痛、一般健康状况、精力、情感职能、精神健康)的评分均显著高于非手术组(P<0.05);观察期间非手术组死亡4例(13.3%),手术组死亡2例(5.4%),两组死亡率差异有统计学意义(P<0.05).结论PTX可明显改善MHD合并严重SHPT患者的钙磷代谢紊乱,术后12个月患者生活质量明显改善,死亡率降低.Objective To investigate the effect of life quality of parathyroidectomy(PTX)in maintenance hemodialysis(MHD)patients with secondary hyperparathyroidism(SHPT).Methods End-stage renal disease(ESRD)patients with SHPT who were on long-term MHD in our hospital from 2014 to 2017 were assigned,based on whether consent to undergo surgery was given,to either the surgery group(the observation group)to receive PTX or the non-surgery group(the control group)to receive conservative medical treatment.The two groups were compared for biochemistries,Short Form 36 Health Survey Questionnaire(SF-36)quality of life scores.Results 67 patients were included,including 37 in surgical group and 30 in non-surgical group.There was no statistical difference between the two groups in age,dialysis age,primary morbidity,intact parathyroid hormone(iPTH),blood calcium,blood phosphorus,hemoglobin(HGB)and albumin(Alb)concentration(P>0.05).At 12 months after surgery or conservative treatment,the blood product levels of iPTH,blood calcium,blood phosphorus,and calcium phosphorus in the surgical group were significantly lower than those in the non-surgical group(P<0.05).There was no statistical difference between HGB and the blood Alb levels(P>0.05).In addition to social functions,the SF-36 score of the surgical group after 12 months was significantly higher than that of the non-surgical group(P<0.05).During the observation period,there were 4 deaths(13.3%)in the non-surgical group and 2 deaths(5.4%)in the surgical group(P<0.05).Conclusions PTX could obviously improve both the calcium and phosphorus metabolism disorder in MHD patients with severe SHPT and the quality of life for 12 months after operation,and reduce the mortality rate.

关 键 词：继发性甲状旁腺机能亢进症 甲状旁腺切除术 生活质量 简明健康调查问卷 

分 类 号：R69[医药卫生—泌尿科学]