难治性继发性甲状旁腺功能亢进症患者甲状旁腺重量与血生化水平的关系  

The relationship between parathyroid weight and blood biochemical levels in patients with refractory secondary hyperparathyroidism

作　　者：孟娇 陈昊路 宋春轶[2] 李华[1] MENG Jiao;CHEN Hao-lu;SONG Chun-yi;LI Hua(Department of Nephrology and Sir Run Run Shaw Hospital,Xiasha Campus,Zhejiang University School of Medicine,Hangzhou310016,China;Department of Head and Neck Surgery,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院下沙院区肾内科,杭州300016 [2]浙江大学医学院附属邵逸夫医院头颈外科,杭州300016

出　　处：《中国血液净化》2020年第10期664-668,共5页Chinese Journal of Blood Purification

基　　金：浙江省自然科学基金(H0508-Y15H050011)。

摘　　要：目的研究难治性继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)患者甲状旁腺重量与血生化水平,尤其是血清全段甲状旁腺素水平(intact parathyroid hormone,iPTH)之间的关系。方法收集2018年1月~2019年12月期间在浙江大学附属邵逸夫医院下沙院区行首次甲状旁腺全切除术(parathyroidectomy,PTX)的43例难治性SHPT患者的临床资料,采用多因素线性回归分析切除的甲状旁腺总重量与透析龄、血清校正钙、血磷、iPTH、血碱性磷酸酶(serum alkaline phosphatase,ALP)水平的相关性;并通过Spearman秩相关分析甲状旁腺重量与甲状旁腺体积、甲状旁腺最大长径、iPTH之间的相关性。结果43例患者术中探查发现并切除甲状旁腺共169枚。Spearman秩相关分析显示甲状旁腺重量与甲状旁腺体积、甲状旁腺最大长径呈正相关性(r值分别为0.915、0.778,P值均<0.001),iPTH与甲状旁腺重量和体积均无相关性(r值分别为0.143、0.080,P值分别为0.361、0.611)。结论在难治性SHPT患者中,术前血生化水平包括iPTH,不一定能反应出患者甲状旁腺实际的增生情况,无法完全代表甲状旁腺的功能。Objective To evaluate the relationship between parathyroid weight and pre-operative blood biochemical levels,especially pre-operative serum total parathyroid hormone level(iPTH),in patients with refractory secondary hyperparathyroidism(SHPT).Methods Clinical data of the 43 patients with refractory SHPT and undergoing the first parathyroidectomy(PTX)in Sir Run Run Shaw Hospital from January 2018 to December 2019 were retrospectively reviewed.Multivariate linear regression was used to analyze the relationship between the total weight of parathyroid glands and the biochemical levels of corrected serum calcium,blood phosphorus,alkaline phosphatase(ALP)and iPTH before PTX as well as dialysis age of the patients.The relationship between the weight,volume and maximum diameter of parathyroid gland and the iPTH level was investigated by Spearman’s rank correlation coefficient.Results A total of 169 parathyroid glands were found and resected during operation in the 43 patients.Spearman’s rank correlation showed that parathyroid weight was positively correlated with parathyroid volume(r=0.915,P<0.001)and maximum length diameter(r=0.778,P<0.001),but iPTH had no correlation with parathyroid weight(r=0.143,P=0.361)and volume(r=0.080,P=0.611).Conclusion In patients with refractory SHPT,the pre-operative blood biochemical levels including iPTH may not reflect the actual hyperplasia of parathyroid gland and cannot fully represent the function of parathyroid gland.

关 键 词：继发性甲状旁腺功能亢进症 甲状旁腺全切除术 甲状旁腺重量 血清全段甲状旁腺素 

分 类 号：R582.1[医药卫生—内分泌]