不同透析方式对继发性甲状旁腺功能亢进症患者甲状旁腺切除术后长期预后的影响  

Effects of different dialysis modalities on long-term prognosis after parathyroidectomy in patients with secondary hyperparathyroidism

作　　者：刘晓怡 张喆[1] 谢超[1] 侯爱珍[1] 叶佩仪[1] 孔耀中[1] Liu Xiaoyi;Zhang Zhe;Xie Chao;Hou Aizhen;Ye Peiyi;Kong Yaozhong(Department of Nephrology,the First People′s Hospital of Foshan,Foshan 528000,China)

机构地区：[1]佛山市第一人民医院肾内科,佛山528000

出　　处：《中华肾脏病杂志》2022年第5期406-412,共7页Chinese Journal of Nephrology

基　　金：佛山市医学科技创新平台建设项目(FSOAA-KJ218-1301-0033)。

摘　　要：目的比较不同透析方式对继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)患者甲状旁腺切除(parathyroidectomy,PTX)术后生存预后的差异,分析患者生存预后的影响因素。方法回顾性收集和分析2014年4月至2019年5月在佛山市第一人民医院确诊的SHPT并接受PTX治疗的透析患者的临床资料。按照患者术前透析方式的不同分为血液透析(hemodialysis,HD)组和腹膜透析(peritoneal dialysis,PD)组,比较两组患者基线临床资料和心脏彩色超声检查结果的差异。Kaplan-Meier生存曲线比较两组患者累积生存率的差异。多因素Cox回归模型法分析患者全因死亡的影响因素。用受试者工作特征曲线(ROC曲线)预测患者全因死亡的风险。结果共99例患者被纳入本研究,94例患者完成随访,其中死亡23例。与PD组(n=45)比较,HD组(n=54)患者透析龄、血压、全段甲状旁腺素、碱性磷酸酶、总心脏瓣膜钙化率、二尖瓣瓣膜钙化比例、舒张末期室间隔厚度(IVST)和左心室质量指数较高(均P<0.05)。中位随访时间为46.00(32.75,60.25)个月,Kaplan-Meier生存分析结果显示,HD组与PD组患者累积生存率的差异无统计学意义(Log-rank检验χ2=0.414,P=0.520)。多因素Cox回归分析结果显示,年龄增加(HR=1.066,95%CI 1.017~1.118,P=0.008)、收缩压>140 mmHg(HR=2.601,95%CI 1.002~6.752,P=0.049)及IVST增厚(HR=1.269,95%CI 1.036~1.554,P=0.021)为PTX术后患者全因死亡的独立影响因素。ROC曲线分析结果显示,年龄、透析龄和IVST预测透析患者PTX术后全因死亡的截断值分别为51.5岁(AUC=0.673,95%CI 0.545~0.802,P=0.013)、75.0个月(AUC=0.654,95%CI 0.528~0.780,P=0.027)和13.5 mm(AUC=0.680,95%CI 0.557~0.803,P=0.010)。年龄、透析龄、IVST、左心室肥厚及收缩压>140 mmHg联合预测患者PTX术后全因死亡的AUC为0.776(95%CI 0.677~0.875,P<0.001)。结论HD与PD患者PTX术后累积生存率无显著差异,年龄增加、收缩压>140 mmHg及IVST增厚是透析Objective To compare the survival rate of secondary hyperparathyroidism(SHPT)patients with different dialysis modalities after parathyroidectomy(PTX),and analyze the influencing factors of survival prognosis.Methods Clinical data of dialysis patients diagnosed with SHPT and treated with PTX in the First People′s Hospital of Foshan from April 2014 to May 2019 were retrospectively collected and analyzed.The patients were divided into hemodialysis(HD)group and peritoneal dialysis(PD)group according to preoperative dialysis modalities,and the differences in baseline clinical data and cardiac ultrasound results were compared between the two groups.Kaplan-Meier survival analysis was used to compare the difference in cumulative survival rate between the two groups.Multivariate Cox regression model was used to analyze the influencing factors of all-cause death.Receiver operating characteristic curve(ROC curve)was used to predict the risk of all-cause death.Results A total of 99 patients were enrolled in this study,and 94 patients completed follow-up,including 23 patients who died.Compared with PD group(n=45),HD group(n=54)had higher dialysis age,blood pressure,intact parathyroid hormone,alkaline phosphatase,total heart valve calcification rate,mitral valve calcification proportion,interventricular septal thickness(IVST)and left ventricular mass index(all P<0.05).The median follow-up time was 46.00(32.75,60.25)months.Kaplan-Meier survival analysis showed that there was no significant difference in cumulative survival rate between HD group and PD group(Log-rank testχ2=0.414,P=0.520).Multivariate Cox regression analysis showed that increasing age(HR=1.066,95%CI 1.017-1.118,P=0.008),systolic blood pressure>140 mmHg(HR=2.601,95%CI 1.002-6.752,P=0.049)and increasing IVST(HR=1.269,95%CI 1.036-1.554,P=0.021)were independent influencing factors for all-cause death in dialysis patients after PTX.ROC curve analysis results showed that the cut-off values of age,dialysis age and IVST for predicting all-cause death after PTX were 5

关 键 词：甲状旁腺功能亢进症 继发性 甲状旁腺切除术 肾透析 腹膜透析 预后 

分 类 号：R692.5[医药卫生—泌尿科学] R653[医药卫生—外科学]