尿毒症继发性甲状旁腺功能亢进患者行PTX+AT对肢体活动和睡眠质量的影响  

Effects of parathyroidectomy with autotransplantation on limb activities and sleep quality among uremic patients

作　　者：陈亚巍 于涛 李玲 孙新增 王冬 Chen Yawei;Yu Tao;Li Ling(Department of Nephrology,the 983rd Hospital of Joint Logistics Support Force,Tianjin 300142,China)

机构地区：[1]联勤保障部队第983医院肾脏内科,天津300142 [2]空军杭州持勤疗养中心疗养三区

出　　处：《中华保健医学杂志》2023年第4期440-443,共4页Chinese Journal of Health Care and Medicine

基　　金：第九八三医院科学技术“孵育”计划(983 YN22F05)。

摘　　要：目的探讨尿毒症患者并发继发性甲状旁腺亢进(secondary hyperparathyroidism,SHPT)行甲状旁腺全切术+前臂移植(total parathyroidectomy with autotransplantation,PTX+AT)对肌力、不安腿综合征和睡眠质量等的影响。方法回顾性队列选取2020年1月~2021年12月解放军联勤保障部队第983医院收治的SHPT患者62例,分为手术治疗组32例,药物治疗组30例。所有患者规律随访,治疗后第4周、第12周进行肌力、睡眠质量、不安腿综合征症状的评估。观察治疗前后全段甲状旁腺激素(intact parathyroid hormone,iPTH)、血钙(Ca)、血磷(P)等指标的变化。结果与药物治疗组相比,治疗4周和12周后,手术治疗组Ca、P、iPTH水平均显著降低,差异有统计学意义(P<0.001)。5次坐立试验(ST-5)、国际不安腿综合征评估量表(IRLS)、匹兹堡睡眠质量指数量表(PSQI)评分显著降低,差异有统计学意义(P<0.001);而上肢握力无明显变化,差异无统计学意义(P>0.05)。结论PTX+AT是治疗SHPT的有效手段,在降低Ca、P、iPTH的同时,可增强尿毒症患者下肢肌力,改善睡眠质量,减轻不安腿综合征临床表现。Objective To investigate the clinical efficacy of parathyroidectomy with autotransplantation(PTX+AT)on muscle force,restless legs syndrome(RLS)and sleep quality among secondary hyperparathyroidism(SHPT)patients.Methods 62 uremic patients with renal replacement therapy from January 2020 to December 2021 were enrolled,and their data were retrospectively analyzed.Thirty-two SHPT patients were treated with PTX+AT and thirty patients were treated with medicine.The data about international restless legs syndrome study group rating scale(IRLS),5 times sit-to-stand test(ST-5)and Pittsburgh sleep quality index(PSQI)were analyzed to evaluate the symptom of RLS,the muscle force of lower limbs and sleeping quality before and after the intervention in both groups.Serum intact parathyroid hormone(iPTH),calcium(Ca),phosphorus(P)obtained preoperatively and postoperatively were collected and compared.Results Compared with the medcine group,serum iPTH,Ca,and P decreased significantly in postoperative period(P<0.001),and the scores of IRLS,ST-5 and PSQI were significantly decreased(P<0.001).However,the grip strength were no difference compared with the the medicine group(P>0.05).Conclusion The PTX+AT can effectively decrease iPTH level and regulate the calcium-phosphorus disorder,and also relieve the symptom of RLS,enhance the muscle force of lower limbs and improve the sleeping quality.

关 键 词：尿毒症 继发性甲状旁腺功能亢进 不安腿综合征 肌力 睡眠质量 

分 类 号：R589[医药卫生—内分泌]