继发性甲状旁腺功能亢进症患者行甲状旁腺全切和自体移植后移植物存活率及对钙磷代谢的影响  

Graft survival rate and its influence on calcium and phosphorus metabolism after total parathyroidectomy and auto-transplantation in patients with secondary hyperparathyroidism

作　　者：潘斌 陈思瑜 雷欣 陈江华 张萍 Pan Bin;Chen Siyu;Lei Xin;Chen Jianghua;Zhang Ping(Department of Nephropathy,the Fourth Affiliated Hospital,International Institutes of Medicine,Zhejiang University School of Medicine,Yiwu 322000,China;Kidney Disease Center,the First Affiliated Hospital,College of Medicine,Zhejiang University Key Laboratory of Kidney Disease Prevention and Control Technology,Zhejiang Province National Key Clinical Department of Kidney Diseases Institute of Nephrology,Zhejiang University Zhejiang Clinical Research Center of Kidney and Urinary System Disease,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属第四医院肾病科,浙江大学国际健康医学研究院,义乌322000 [2]浙江大学医学院附属第一医院肾脏病中心,浙江省肾脏病防治技术研究重点实验室,国家临床重点专科浙江大学肾脏病研究所,浙江省肾脏与泌尿系统疾病临床医学研究中心,杭州310003

出　　处：《中华肾脏病杂志》2023年第12期919-926,共8页Chinese Journal of Nephrology

摘　　要：目的探讨继发性甲状旁腺亢进症(secondary hyperparathyroidism,SHPT)患者接受甲状旁腺全切和前臂肌肉自体移植术后移植物的存活率,以及移植物存活情况对钙磷代谢的影响。方法该研究为回顾性队列研究。纳入2015年11月至2018年12月于浙江大学医学院附属第一医院确诊SHPT,并符合手术指征接受甲状旁腺切除加前臂肌肉种植术的终末期肾病患者。收集患者一般临床资料,包括术前和术后1周、1个月、6个月血钙、血磷、全段甲状旁腺素、碱性磷酸酶,以及术后1个月、6个月补充钙剂和骨化三醇的累积剂量。总结移植物存活率,并分组比较移植物存活组和未存活组患者术后血钙、血磷以及补充钙剂、骨化三醇剂量的差异。结果共有191例患者纳入该研究,男性95例(49.7%),年龄<60岁172例(90.1%),移植物存活154例(80.6%)。两组患者术后1周、1个月、6个月时血钙、血磷、碱性磷酸酶以及术后1个月、6个月碳酸钙累积用量差异均无统计学意义(均P>0.05)。移植物未存活组术后1个月骨化三醇累积用量显著大于存活组[41.50(30.00,45.00)μg比32.75(25.50,40.50)μg,Z=-2.307,P=0.021],而术后6个月两组骨化三醇累积用量差异无统计学意义(P>0.05)。结论SHPT患者行甲状旁腺全切和前臂肌肉种植术后移植物存活率较高,术后6个月移植物存活组与未存活组血钙、血磷、钙剂和骨化三醇累积补充剂量无显著差异。Objective To investigate the graft survival rate after total parathyroidectomy(TPTX)plus forearm muscle auto-transplantation in patients with secondary hyperparathyroidism(SHPT)and evaluate the effect of graft survival status on calcium and phosphorus metabolism.Methods It was a retrospective cohort study.The end-stage renal disease patients who were diagnosed with SHPT and underwent TPTX plus forearm muscle auto-transplantation from November 2015 to December 2018 at the First Affiliated Hospital of Zhejiang University School of Medicine were enrolled.The clinical data including serum calcium,phosphorus,intact parathyroid hormone and alkaline phosphatase preoperative and postoperative 1 week,1 month and 6 months,and cumulative requirements of calcium carbonate and calcitriol in postoperative 1 month and 6 months were collected.The graft survival rate was summarized and the differences of serum calcium,phosphorus,and supplementation dosage of calcium and calcitriol after surgery between the graft survival group and the graft non-survival group were compared.Results A total of 191 patients were included in the study,with 95 males(49.7%),and 172 patients of age<60 years old.There were 154 grafts surviving with a graft survival rate of 80.6%.There were no significant differences in the levels of serum calcium,phosphorus,alkaline phosphatase at 1 week,1 month and 6 months after surgery,and cumulative dosage of calcium carbonate at 1 month and 6 months after surgery between the two groups(all P>0.05).The dose of calcitriol in the graft non-survival group was significantly higher than that in the graft survival group within 1 month after surgery[41.50(30.00,45.00)μg vs.32.75(25.50,40.50)μg,Z=-2.307,P=0.021].However,there was no significant difference in cumulative calcitriol supplementation between the two groups within 6 months after surgery(P>0.05).Conclusions The graft survival rate after TPTX plus forearm muscle auto-transplantation is high in SHPT patients.Within 6 months after surgery,there is no significant dif

关 键 词：肾功能不全 慢性 甲状旁腺切除术 移植物存活 继发性甲状旁腺功能亢进症 自体前臂肌肉移植术 钙磷代谢 

分 类 号：R653[医药卫生—外科学]