伴有甲状旁腺功能亢进的肾移植患者行甲状旁腺切除术的手术时机对移植肾功能的影响  

Effect of operation timing of parathyroidectomy on renal allograft function in renal transplant patients with hyperparathyroidism

作　　者：段志强 林涛[2] 刘洋 张良 刘奎 芦思好 刘佳丽[3] DUAN Zhiqiang;LIN Tao;LIU Yang;ZHANG Liang;LIU Kui;LU Sihao;LIU Jiali(Department of Nephrology,Air Force Hospital of Western Theater Command,Chengdu 610021,China;Department of Urology,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Nephrology,The Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan,China)

机构地区：[1]西部战区空军医院肾病内科,四川成都610021 [2]四川大学华西医院泌尿外科,四川成都610041 [3]川北医学院附属医院肾内科,四川南充637000

出　　处：《西部医学》2024年第2期237-242,247,共7页Medical Journal of West China

摘　　要：目的 探讨伴有持续甲状旁腺功能亢进的肾移植患者行甲状旁腺切除术的手术时机对移植肾功能的影响。方法 纳入2000年1月—2019年8月在四川大学华西医院及西部战区空军医院行同种异体肾移植术并行甲状旁腺切除术(PTX)联合前臂移植的患者27例,按肾移植手术与PTX联合前臂移植手术间隔时间进行分组,分为肾移植术后12月内(0~12月)组、12~24月组、24~36月组、>36月组。分析比较各组患者白蛋白、血肌酐、肾小球滤过率、甲状旁腺激素、血钙、血磷以及碱性磷酸酶的分布情况。结果 肾移植术前甲状旁腺激素、血钙、碱性磷酸酶、血肌酐、eGFR及血清白蛋白各组间比较差异无统计学意义(均P>0.05);0~12月组血磷水平与24~36月组组间差异有统计学意义(P<0.05)。在术后1周、1月、3月、1年,各组间血钙差异均无统计学意义(P>0.05);在术后6月,12~24月组和24~36月组血钙水平相当(P>0.05),0~12月组血钙最低,>36月组最高(P<0.05)。在PTX联合前臂移植术后各个时间点,12~24月组血磷最低,除术后1月外,其余各个时间点组间差异均有统计学意义(P<0.05);而>36月组,在PTX联合前臂移植术后1周、3个月、6个月及12个月,其血磷水平均最高(P<0.05)。>36月组的碱性磷酸酶水平在PTX联合前臂移植术前及术后各个时间点均明显低于其余各组(P<0.05),而0~12月组、12~24月组和24~36月组在PTX联合前臂移植术后各时间点间碱性磷酸酶水平相当(P>0.05)。PTX联合前臂移植术后各个时间点,各组的血清白蛋白亦均在正常范围内,血清白蛋白及血肌酐组间差异均无统计学意义(P>0.05)。PTX联合前臂移植术后各个时间点,12~24月组肾小球滤过率均最高,且明显高于其他组,差异有统计学意义(均P<0.05)。结论 伴有持续甲状旁腺功能亢进的肾移植患者行PTX联合前臂移植的最佳手术时机是移植后12~24月,其对移植肾功能影响最小。Objective To investigate the effect of surgical timing of parathyroidectomy on renal transplant function in renal transplant patients with persistent hyperparathyroidism.Methods The data of all patients who underwent allogeneic kidney transplantation combined with parathyroidectomy(PTX)combined with forearm transplantation in West China Hospital of Sichuan University and the Air Force Hospital of the Western Theater Command from January 2000 to August 2019 were collected.The timing of forearm transplantation(0-12 months,12-24 months,24-36 months,and more than 36 months)in each group of patients with albumin,serum creatinine,glomerular filtration rate,parathyroid hormone,serum calcium,serum phosphorus and the distribution of alkaline phosphatase.Results At 1 week,1 month,3 months and 1 year after operation,there was no statistical difference in serum calcium among the groups;at 6 months after operation,the blood calcium in the 0-12 month group was the lowest,and the>36 month group was the highest.At each time point after PTX combined with forearm transplantation,the serum phosphorus in the 12-24 month group was the lowest,except for 1 month after the operation,the differences in the other time points were statistically significant;while in the>36 month group,the serum phosphorus level was the highest at 1 week,3 months,6 months and 12 months after PTX combined with forearm transplantation.The alkaline phosphatase level of the>36 month group was significantly lower than that of the other groups before and after PTX combined with forearm transplantation,while in the 0-12 month group,the 12-24 month group and the 24-36 month group the levels of alkaline phosphatase at each time point after PTX combined with forearm transplantation were similar.At each time point after PTX combined with forearm transplantation,the serum albumin of each group was also within the normal range,and there was no statistical difference between the groups.At each time point after PTX combined with forearm transplantation,the glomerular filtr

关 键 词：肾移植 甲状旁腺功能亢进 甲状旁腺切除术 肾小球滤过率 

分 类 号：R581.1[医药卫生—内分泌]