不同透析方式发生难治性继发性甲状旁腺功能亢进的临床与病理关系分析  

Analysis of the relationship between clinical and pathological feature of refractory secondary hyperparathyroidism in different dialysis methods

作　　者：田杰[1] 谢超[2] 叶佩仪[2] 周东华[1] 孔耀中[2] TIAN Jie(Department of the pathology,Foshan maternal and child health hospital,Foshan,Guangdong,528000,China.)

机构地区：[1]佛山市妇幼保健院病理科,广东佛山528000 [2]佛山市第一人民医院肾内科,广东佛山528000

出　　处：《齐齐哈尔医学院学报》2020年第9期1095-1097,共3页Journal of Qiqihar Medical University

摘　　要：目的明确采用不同透析方式的维持性透析患者发生难治性继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)的临床与病理关系。方法回顾性分析2014年1月—2019年5月因难治性SHPT而行手术的维持性透析患者的临床资料及病理结果,分析维持性透析患者发生难治性SHPT的病理特点及其与临床的关系。结果共105例患者行甲状旁腺切除术,其中维持性血液透析患者54例,腹膜透析患者51例。腹膜透析患者发生难治性SHPT的透析龄显著短于血液透析患者,差异具有统计学意义(P<0.01)。术后病理结果提示甲状旁腺弥漫性增生83例,甲状旁腺结节/腺瘤样增生22例。分析两组的临床特点发现,两者在性别、透析龄及透析方式无显著差异,而伴有结节/腺瘤样增生的患者较弥漫增生患者年轻,差异具有统计学意义(P<0.05)。Logistic回归分析发现,年龄是甲状旁腺结节/腺瘤样增生发生的独立影响因素(OR=0.951,95%CI(0.906,0.997),P=0.038)。结论维持性透析患者的难治性SHPT主要病理改变以甲状旁腺弥漫增生为主,而结节/腺瘤样增生在相对年轻的患者中高发,年龄是难治性SHPT的唯一独立影响因素。相较血液透析患者,腹膜透析患者更早发生难治性SHPT。Objective To study the relationship between clinical and pathological features of refractory secondary hyperparathyroidism in maintenance dialysis patients received different dialysis treatments.Methods The clinical data and pathological results of maintenance dialysis patients who underwent surgery for refractory secondary hyperparathyroidism were collected.The pathological characteristics of refractory secondary hyperparathyroidism and its relationship with clinic indicators were analyzed.Results A total of 105 maintenance dialysis patients underwent parathyroidectomy,including 54 hemodialysis patients and 51 peritoneal dialysis patients.The average time from the beginning of dialysis to the onset of refractory secondary hyperparathyroidism among peritoneal dialysis patients was significantly shorter than that of hemodialysis patients(P<0.01).There were 83 cases of diffuse hyperplasia and 22 cases of nodule/adenomatoid hyperplasia of parathyroid glands according the pathological results.The analysis of the clinical features revealed that there was no significant differences in sex,dialysis age and dialysis method between the two groups.The patients with nodular/adenomatoid hyperplasia of parathyroid gland were younger than those with diffuse hyperplasia of parathyroid gland(P<0.05).Logistic regression analysis indicated that only age was the independent risk factor of parathyroid nodule/adenomatous hyperplasia(OR=0.951,95%CI(0.906,0.997),P=0.038).Conclusions The main pathological changes of refractory secondary hyperparathyroidism in maintenance dialysis patients are parathyroid hyperplasia,while the frequency of nodular/adenomatous hyperplasia is much higher in relatively young patients,and age is the only independent risk factor of refractory SHPT.Compared to hemodialysis patients,the refractory secondary hyperparathyroidism occurs much earlier in peritoneal dialysis patients.

关 键 词：难治性继发性甲状旁腺功能亢进 血液透析 腹膜透析 病理 

分 类 号：R581.1[医药卫生—内分泌]