不同方法治疗维持性血液透析并发难治性继发性甲状旁腺功能亢进临床观察  

Clinical observation of three different methods in treatment of refractory secondary hyperparathyroidism in patients with maintenance hemodialysis

作　　者：廖琳[1] 胡静[1] 孙永康[2] 陈杰[1] 施倩[2] 路建饶[1] LIAO Lin;HU Jing;SUN Yongkang;CHEN Jie;SHI Qian;LU Jianrao(Department of Nephrology,Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200137,China;不详)

机构地区：[1]上海中医药大学附属第七人民医院肾病科,上海200137 [2]上海中医药大学附属第七人民医院超声医学科

出　　处：《山东医药》2023年第4期27-32,共6页Shandong Medical Journal

基　　金：上海市浦东新区卫计委面上项目(PW2019A-19);上海市第七人民医院“启明星”培养计划(QMX2019-02)。

摘　　要：目的对比药物、超声引导下激光消融术及甲状旁腺全切+前臂移植术(TPTX+AT)治疗维持性血液透析(MHD)并发难治性继发性甲状旁腺功能亢进(SHPT)的临床疗效。方法选择接受MHD治疗的尿毒症并发难治性SHPT患者60例,按随机数字表法分为药物组、手术1组、手术2组各20例。药物组予西那卡塞联合小剂量骨化三醇治疗,手术1组予超声引导下激光消融术治疗,手术2组予TPTX+AT治疗。分别于治疗前及治疗1周、1个月、3个月、6个月、12个月,采用视觉模拟评分法(VAS)评价患者主要症状,用肾病相关生活质量量表(KDTA)评分评价患者生活质量,检测血红蛋白(Hb)、血清白蛋白(Alb)、钙、磷、血清全段甲状旁腺激素(iPTH),采用多普勒超声测定颈动脉内膜中层厚度(IMT)、颈动脉阻力指数(RI)。统计手术1组、手术2组的手术时间、住院时间,观察并发症发生情况。结果治疗1、3、6、12个月,药物组VAS、KDTA评分较治疗前改善(P均<0.05),但改善程度低于手术1组、手术2组(P均<0.05);手术1组、手术2组从治疗1周及1、3、6、12个月VAS、KDTA评分较治疗前改善(P均<0.05),但两组间各时间点VAS、KDTA评分比较差异无统计学意义(P均>0.05)。治疗1、3、6、12个月,手术1组、手术2组Hb、Alb较治疗前升高,且高于药物组(P均<0.05);手术1组与手术2组各时间点Hb、Alb比较差异无统计学意义(P均>0.05)。治疗3个月后,药物组血钙、磷、iPTH逐渐下降,与治疗前比较差异有统计学意义(P均<0.05)。治疗1周,手术1组、手术2组血钙、磷、iPTH迅速下降,治疗1个月开始上升,治疗3个月趋于稳定,但均低于术前及药物组(P均<0.05);其中治疗1周,手术2组血钙、iPTH低于手术1组(P均<0.05)。治疗前、治疗6个月三组IMT、RI比较差异均无统计学意义(P均>0.05);治疗12个月,手术1组、手术2组IMT、RI均较治疗前下降,但药物组IMT、RI较治疗前升高,手术1组、手术2组IMT�Objective To compare the clinical efficacy of drug,ultrasound-guided laser ablation and total parathyroidectomy+forearm transplantation(TPTX+AT)in the treatment of refractory secondary hyperparathyroidism(SHPT)in patients with maintenance hemodialysis(MHD).Methods Sixty patients with uremia complicated with refractory SHPT who received MHD treatment were randomly divided into the drug group,operative group 1 and operative group 2,with 20 cases in each.Patients in the drug group were treated with cinacalcet and low-dose calcitriol,the operative group 1 with ultrasound-guided laser ablation,and the operative group 2 with TPTX+AT.The patients’main symptoms were evaluated by visual analogue scale(VAS),quality of life was evaluated by kidney disease targeted areas(KDTA),and hemoglobin(Hb),serum albumin(Alb),calcium,phosphorus,serum intact parathyroid hormone(iPTH)were measured;carotid intima-media thickness(IMT)and carotid artery resistance index(RI)were measured by Doppler ultrasound before treatment and 1 week,1 month,3 months,6 months and 12 months after treatment.The operative time and hospitalization time of the operative group 1 and the operative group 2 were counted,and the complications were observed.Results The VAS and KDTA scores at 1,3,6 and 12 months of treatment were improved as compared with those before treatment in the drug group(all P<0.05),but the improvement degree was lower than those in the operative group 1 and operative group 2(all P<0.05).The VAS and KDTA scores were improved from 1 week and 1,3,6 and 12 months after treatment(all P<0.05)in comparison with those before treatment in the operative group 1 and operative group 2(all P<0.05),but there was no significant difference between the two groups at different time points(P>0.05).Serum Hb and Alb at 1,3,6 and 12 months after treatment were higher than those before treatment in the operative group 1 and operative group 2,and were higher than those in the drug group(all P<0.05).There were no significant differences in Hb or Alb at each time po

关 键 词：继发性甲状旁腺功能亢进 尿毒症 维持性血液透析 西那卡塞 超声引导下激光消融术 甲状旁腺切除术 前臂移植术 

分 类 号：R582[医药卫生—内分泌]