甲状旁腺切除术对慢性肾脏病5期伴严重继发性甲状旁腺功能亢进患者心率昼夜节律的影响  

Effects of parathyroidectomy on heart rate circadian rhythm in patients with stage 5 chronic kidney disease combined with severe secondary hyperparathyroidism

作　　者：崔颖 黄慧 任文凯 杨光 曾鸣 查小明 唐少文[2] 黄耀禹 高占辉[4] 徐方燕 周文斌 钱寒阳 王静 欧阳春 高雪艳[6] 邢昌赢[1] 魏永越 王宁宁[1] Cui Ying;Huang Hui;Ren Wenkai;Yang Guang;Zeng Ming;Zha Xiaoming;Tang Shaowen;Huang Yaoyu;Gao Zhanhui;Xu Fangyan;Zhou Wenbin;Qian Hanyang;Wang Jing;Ouyang Chun;Gao Xueyan;Xing Changying;Wei Yongyue;Wang Ningning(Department of Nephrology,The First Affiliated Hospital of Nanjing Medical University,Jiangsu Province Hospital,Nanjing 210029,China;Department of Epidemiology and Biostatistics,School of Public Health,Nanjing Medical University,Nanjing 211166,China;Department of General Surgery,The First Affiliated Hospital of Nanjing Medical University,Jiangsu Province Hospital,Nanjing 210029,China;Department of Nephrology,BenQ Medical Center,The Affiliated BenQ Hospital of Nanjing Medical University,Nanjing 210019,China;Department of Nephrology,Liyang Branch,Jiangsu Province Hospital,Liyang People's Hospital,Liyang 213300,China;Department of General Medicine,Geriatric Hospital of Nanjing Medical University,Nanjing 210024,China;China International Cooperation Center for Environment and Human Health,Nanjing Medical University,Nanjing 211166,China;Department of Nephrology,Northern Jiangsu People's Hospital,Yangzhou 225001,China)

机构地区：[1]南京医科大学第一附属医院肾内科,江苏省人民医院肾内科,南京210029 [2]南京医科大学公共卫生学院流行病学与生物统计学系,南京211166 [3]南京医科大学第一附属医院普外科,江苏省人民医院普外科,南京210029 [4]南京医科大学附属明基医院肾内科,南京210019 [5]江苏省人民医院溧阳分院肾内科,溧阳市人民医院肾内科,溧阳213300 [6]南京医科大学附属老年病医院全科医学科,南京210024 [7]南京医科大学公共卫生学院环境与人类健康国际联合研究中心,南京211166 [8]苏北人民医院肾内科,扬州225001

出　　处：《中华肾脏病杂志》2021年第5期414-423,共10页Chinese Journal of Nephrology

基　　金：国家自然科学基金(81270408、81570666);国际肾脏病学会临床研究项目(18-01-0247);江苏省临床医学研究中心支撑体系建设(BL2014084);江苏省“医学重点人才”项目(ZDRCA2016002、RC201162);中华国际医学交流基金会肾性贫血科研基金(Z-2017-24-2037);南京医科大学第一附属医院(江苏省人民医院)优秀中青年人才支持计划。

摘　　要：目的观察慢性肾脏病(chronic kidney disease,CKD)5期患者心率昼夜节律的变化,分析甲状旁腺切除术(parathyroidectomy,PTX)对伴严重继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)患者心率节律的影响。方法横断面观察213例CKD 5期患者和96例健康对照人群,患者分为不伴严重SHPT组(非PTX组,n=143)和伴严重SHPT行PTX组(PTX组,n=70),前瞻随访46例PTX患者,比较各组的基本资料。各组人群均行动态心电图检查,夜/昼心率比值>0.9定义为非勺型心率。CKD 5期患者心率昼夜节律指标的相关因素采用多因素线性回归分析。结果CKD 5期患者PTX组和非PTX组24 h、白天、夜间平均心率均高于健康对照组,PTX组最为显著(均P<0.05)。健康对照组和CKD患者的夜/昼心率比值分别为(0.81±0.08)、(0.91±0.08)(P<0.01)。多因素线性回归结果显示,患者24 h、白天及夜间平均心率与血磷、ln(碱性磷酸酶)呈正相关,夜间平均心率、夜/昼心率比值与血全段甲状旁腺素水平呈正相关(均P<0.05)。校正术后随访时间(中位时间10.9个月)后,PTX患者术后的24 h和夜间平均心率以及夜/昼心率比值均明显降低(均P<0.01)。结论CKD 5期患者心率升高且昼夜节律异常,与骨矿物质代谢紊乱相关。PTX显著降低SHPT患者的24 h、夜间平均心率及夜/昼心率比值,改善CKD患者的心率昼夜节律。Objective To observe heart rate circadian rhythm in patients with chronic kidney disease(CKD)stage 5 and to analyze the effects of parathyroidectomy(PTX)on heart rate circadian rhythm in severe secondary hyperparathyroidism(SHPT)patients.Methods A cross-sectional observation was performed in 213 patients with CKD stage 5 and 96 controls,and the patients were divided into those with severe SHPT(PTX group,n=70)and without severe SHPT(non-PTX group,n=143).Forty-six PTX patients were followed up prospectively.The baseline data were compared among these groups.Holter electrocardiogram was performed for each participant.Non-dipping heart rate was defined as night/day heart rate ratio greater than 0.9.Multiple linear regression analysis was used to analyze the related factors of heart rate circadian rhythm in patients with CKD stage 5.Results The 24-hour,daytime and nighttime mean heart rate in patients with CKD stage 5 were all higher than those in controls,especially in PTX group(all P<0.05).The night/day heart rate ratios of controls and CKD stage 5 patients were(0.81±0.08)and(0.91±0.08)respectively(P<0.01).Correlation analysis showed 24-hour and daytime or nighttime mean heart rate in patients with CKD stage 5 were positively correlated with serum levels of phosphorus and ln(alkaline phosphatase),while nighttime mean heart rate and night/day heart rate ratio were positively related with serum intact parathyroid hormone level.After adjusting with postoperative follow-up period(median time:10.9 months),24-hour and nighttime mean heart rate,and night/day heart rate ratio in PTX patients all decreased significantly(all P<0.01).Conclusions Heart rate is increased and circadian rhythm is abnormal in patients with CKD stage 5,which are related with mineral and bone disorder.PTX significantly decreases 24-hour and nighttime mean heart rate in severe SHPT patients,and improves the heart rate circadian rhythm.

关 键 词：慢性肾疾病-矿物质和骨代谢异常 甲状旁腺切除术 甲状旁腺素 心率 昼夜节律 非勺型心率 

分 类 号：R653[医药卫生—外科学] R692[医药卫生—临床医学]