甲状旁腺全切加自体移植术对血液透析患者继发性甲状旁腺功能亢进的影响  

Effect of Total Parathyroidectomy plus Autologous Transplantation on Secondary Hyperparathyroidism in Maintenance Hemodialysis Patients

作　　者：刘峻 覃娇 文锐[1] 周定刚 LIU Jun;QIN Jiao;WEN Rui(Department of Nephrology,Changsha Central Hospital,Nanhua University,Changsha,Hunan,410004)

机构地区：[1]南华大学附属长沙中心医院肾内科,湖南长沙410004 [2]南华大学附属长沙中心医院耳鼻咽喉头颈外科,湖南长沙410004

出　　处：《医学临床研究》2022年第4期582-585,共4页Journal of Clinical Research

基　　金：湖南省卫生健康委科研计划课题(课题编号:C2019131)。

摘　　要：【目的】探讨甲状旁腺全切加自体移植术对血液透析患者继发性甲状旁腺功能亢进的影响。【方法】回顾性分析2019年7月至2020年8月在本院接受血液透析及手术治疗(甲状旁腺全切+自体移植术)的21例继发性甲状旁腺功能亢进患者的临床资料。收集患者术前及术后不同阶段(1d、1周、1个月、3个月、6个月、12个月)的血常规及生化检测结果(包括血红蛋白、游离钙、磷、甲状旁腺激素、碱性磷酸酶等),临床症状(骨痛、皮肤瘙痒、不宁腿综合征、睡眠障碍等)以及治疗方案,并进行统计学分析。【结果】与术前比较,所有患者术后血钙、血磷、iPTH、ALP均显著下降,差异有统计学意义(P<0.05)。术后患者骨痛、皮肤瘙痒、不宁腿综合征、睡眠情况等症状均得到不同程度的缓解,术后患者血压较术前控制更为良好,维持靶目标血红蛋白水平所需的促红素剂量明显减少。【结论】甲状旁腺全切加自体移植术能显著改善血液透析继发性甲状旁腺功能亢进患者的钙磷代谢紊乱及肾性贫血,降低患者的血压、甲状旁腺激素以及碱性磷酸酶水平,并能有效缓解患者的骨痛、皮肤瘙痒、不宁腿综合征、睡眠障碍等临床症状。【Objective】To observe effect of total parathyroidectomy plus autologous transplantation on secondary hyperparathyroidism in maintenance hemodialysis patients【Methods】The clinical data of 21 patients with secondary hyperparathyroidism who underwent hemodialysis and surgical treatment(total parathyroidectomy+autologous transplantation)in our hospital from July 2019 to August 2020 were analyzed retrospectively.The blood routine and biochemical test results(including hemoglobin,free calcium,phosphorus,parathyroid hormone,alkaline phosphatase,etc.),clinical symptoms(bone pain,skin pruritus,restless legs syndrome,sleep disorder,etc.)and treatment plan of patients at different stages before and after operation(1 day,1 week,1 month,3 months,6 months,12 months)were collected and statistically analyzed.【Results】Compared with before operation,blood calcium,blood phosphorus,iPTH and ALP decreased significantly in all patients(P<0.05).The symptoms of postoperative patients such as bone pain,skin pruritus,restless legs syndrome and sleep were relieved to varying degrees.The blood pressure of postoperative patients was better controlled than that before operation,and the dose of erythropoietin required to maintain the target hemoglobin level was significantly reduced.【Conclusion】Total parathyroidectomy plus autotransplantation can significantly improve calcium/phosphorus metabolism disorder and renal anemia in patients with secondary hyperparathyroidism after hemodialysis,reduce blood pressure,parathyroid hormone and alkaline phosphatase levels,and effectively alleviate clinical symptoms such as bone pain,skin pruritus,restless legs syndrome and sleep disorder.

关 键 词：肾透析/副作用 甲状旁腺功能亢进症 继发性 甲状旁腺切除术 

分 类 号：R459.5[医药卫生—治疗学]