不同术式治疗肾移植后三发性甲状旁腺功能亢进的疗效  

Efficacy of different surgical methods in treatment of tertiary hyperparathyroidism after renal transplantation

作　　者：余永武 熊敏 武曦蔼[2] 程靖宁[3] 杨柳[4] 张凌[4] YU Yongwu;XIONG Min;WU Xi’ai;CHEN Jinning;YANG Liu;ZHANG Ling(Department of Nephrology,Beijing Chuiyangliu Hospital,Beijing 100022,China;Department of TCM Diabetes,China-Japan Friendship Hospital,Beijing 100029,China;Department of Otorhinolaryngology,China-Japan Friendship Hospital,Beijing 100029,China;Department of Nephrology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]北京市垂杨柳医院肾内科,北京100022 [2]中日友好医院中医糖尿病科 [3]中日友好医院耳鼻喉科 [4]中日友好医院肾内科

出　　处：《肾脏病与透析肾移植杂志》2022年第5期432-437,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：首都临床诊疗技术研究及示范应用专题(Z191100006619014)。

摘　　要：目的:探讨甲状旁腺切除术(PTX)和微波消融术(MWA)对肾移植后三发性甲状旁腺功能亢进(THPT)的疗效及对移植肾功能的影响。方法:回顾性分析2016-04-13~2020-08-20在中日友好医院和北京市垂杨柳医院肾性骨病门诊就诊并入院接受PTX和MWA治疗的肾移植后THPT患者的临床资料,比较术前和术后第1天、1月、3月、6月、12月的血钙、血磷、碱性磷酸酶、全段甲状旁腺激素(iPTH)、血清肌酐(SCr)的变化,统计手术成功率、术后并发症及复发情况。结果:纳入资料完整的接受PTX治疗患者12例和MWA治疗患者20例,PTX和MWA组术前血iPTH值分别为334.3(130.7,475.2)pg/mL和193.4(132.2,297.1)pg/mL,术后1天分别降至74.5(14.6,178.1)pg/mL和66.9(38.8,98.7)pg/mL,非参数检验两组治疗前后各时间点iPTH值差异有统计学意义(χ_(PTX)^(2)=31.232,P<0.01;χ_(MWA)^(2)=49.680,P<0.01)。两组治疗后碱性磷酸酶呈显著下降趋势(χ_(PTX)^(2)=35.477,P<0.01;χ_(MWA)^(2)=29.583,P<0.01)。PTX和MWA组治疗前血钙均值分别为(2.78±0.39)mmol/L和(2.73±0.23)mmol/L,治疗后1天分别降至(2.39±0.31)mmol/L和(2.51±0.22)mmol/L,重复测量方差分析显示差异有统计学意义(F_(PTX)=6.617,P<0.01;F_(MWA)=3.776,P=0.021)。PTX和MWA组治疗前后血磷、SCr变化无统计学差异。PTX组术后复发率低于MWA组,差异无统计学意义。结论:PTX和MWA均可有效的改善肾移植后THPT带来的高iPTH、高钙血症,降低碱性磷酸酶水平,且对移植肾功能无影响。与MWA相比,PTX术后THPT复发率更低。Objective:To investigate the efficacy of parathyroidectomy(PTX)and microwave ablation(MWA)in the treatment of tertiary hyperparathyroidism(THPT)after renal transplantation and its effect on renal allograft function.Methodology:The clinical data of THPT patients after renal transplantation who successfully received PTX and MWA treatment in China-Japan Friendship Hospital and Beijing Chuiyangliu Hospital from April 13,2016 to August 20,2020 were retrospectively analyzed.The changes of serum calcium,phosphorus,alkaline phosphatase,intact parathyroid hormone(iPTH)and serum creatinine were compared before operation and 1 day,1 month,3 months,6 months and 12 months after operation.The success rate of operation,postoperative complications and recurrence of THPT were counted.Results:There were 12 patients treated with PTX and 20 patients treated with MWA with complete data were included.The preoperative iPTH values of PTX and MWA groups were 334.3(130.7,475.2)pg/mL and 193.4(132.2,297.1)pg/mL,respectively,which decreased to 74.5(14.6,178.1)pg/mL and 66.9(38.8,98.7)pg/mL one day after operation,respectively.There were statistically significant differences in iPTH values between the two groups at each time point before and after treatment(χ_(PTX)^(2)=31.232,P<0.01;χ_(MWA)^(2)=49.680,P<0.01).Alkaline phosphatase showed a downward trend with statistical significance after treatment(χ_(PTX)^(2)=35.477,P<0.01;χ_(MWA)^(2)=29.583,P<0.01).The mean values of blood calcium in PTX and MWA groups before treatment were(2.78±0.39)mmol/L and(2.73±0.23)mmol/L,respectively,and decreased to(2.39±0.31)mmol/L and(2.51±0.22)mmol/L on the first day after treatment.Analysis of variance of repeated measurements showed that the difference was statistically significant(F_(PTX)=6.617,P<0.01;F_(MWA)=3.776,P=0.021).There were no significant differences in serum phosphorus or creatinine at each time point after PTX and MWA compared with those before surgery(P>0.05).The recurrence rate of PTX group was lower than that of MWA group,but the diffe

关 键 词：肾移植 三发性甲状旁腺功能亢进 甲状旁腺切除术 微波消融术 

分 类 号：R699.2[医药卫生—泌尿科学] R582.1[医药卫生—外科学]