重视继发性甲状旁腺功能亢进患者术后甲状旁腺激素持续过低状态  

Persistent low circulating parathyroid hormone levels after parathyroidectomy for secondary hyperparathyroidism patients with chronic kidney disease

作　　者：钱寒阳 任文凯(综述) 王宁宁(审校) QIAN Hanyang;REN Wenkai;WANG Ningning(Department of Nephrology,the First Affiliated Hospital of Nanjing Medical University,Jiangsu Province Hospital,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院(江苏省人民医院)肾内科,南京210029

出　　处：《肾脏病与透析肾移植杂志》2021年第4期368-373,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家自然科学基金面上项目(81270408,81570666);国际肾脏病学会(ISN)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项目(BL2014084);江苏省“科教强卫工程”医学重点人才项目(ZDRCA2016002);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：继发性甲状旁腺功能亢进(SHPT)是慢性肾脏病(CKD)患者的常见并发症,可导致矿物质骨代谢紊乱、骨异常和异位钙化等。甲状旁腺切除术(PTX)作为一种有效的治疗方法,可以改善对常规内科治疗抵抗的严重SHPT患者的临床表现、提高其生活质量、降低死亡率。然而有报道PTX还可能导致患者血甲状旁腺激素(PTH)水平持续过度降低,产生一系列不良后果,如无动力性骨病、低转运性骨病、血管钙化、死亡率升高等。因此,对伴有SHPT的CKD患者PTX术后持续低PTH水平的发病机制、临床表现以及处理进行综述对临床有参考价值。本文重点介绍PTX后血PTH水平的推荐理想范围、PTX后持续过低PTH状态的临床表现及可能的治疗措施。Chronic kidney disease(CKD)patients often suffer from secondary hyperparathyroidism(SHPT),a complication which causes mineral metabolism disorders,bone abnormality and ectopic calcification.Parathyroidectomy(PTX)can reduce mortality in SHPT patients who resistant to conventional internal medical therapy,improve their clinical manifestations and quality of life.However,it has been reported that PTX also might cause low circulating parathyroid hormone(PTH)levels and develop a series of adverse outcomes such as adynamic bone disease(ABD),low turnover bone disease(LTBD),vascular calcification(VC)and higher mortality,etc.Therefore,it has important clinical value to overview the pathogenesis,clinical manifestations,and managements of low PTH levels after PTX in CKD patients.Here we highlights the suggested optimal range of postoperative serum PTH levels,clinical manifestations and effective treatments for low PTH levels after PTX.

关 键 词：慢性肾脏病 继发性甲状旁腺功能亢进 甲状旁腺切除术 甲状旁腺激素 无动力性骨病 

分 类 号：R653[医药卫生—外科学]