甲状旁腺全切+自体移植术对肾性继发性甲状旁腺功能亢进患者骨密度的影响  

Effect of total parathyroidectomy with autotransplantation on bone mineral density in patients with renal secondary hyperparathyroidism

作　　者：闫军放[1] 宗茜 袁亮[1] 黎淮[1] 包婷 许雯婷 张丹凤[1] 唐伟 YAN Junfang;ZONG Qian;YUAN Liang;LI Huai;BAO Ting;XU Wenting;ZHANG Danfeng;TANG Wei(Department of Nephrology,the Second Affiliated Hospital of Anhui Medical University,Hefei,Anhui Province,230601;Center for Blood Purification,Hefei Fifth People’s Hospital,Hefei Anhui Province,230011,China;Department of Clinical Laboratory,the Second Affiliated Hospital of Anhui Medical University,Hefei,Anhui Province,230601)

机构地区：[1]安徽医科大学第二附属医院肾脏内科,合肥230601 [2]合肥市第五人民医院血液净化中心,合肥230011 [3]安徽医科大学第二附属医院检验科,合肥230601

出　　处：《陆军军医大学学报》2024年第18期2152-2157,共6页Journal of Army Medical University

基　　金：安徽省自然科学基金项目(2308085QH255)。

摘　　要：目的观察甲状旁腺全切+自体移植术(total parathyroidectomy with autotransplantation,tPTx+AT)对继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)患者骨密度(bone mineral density,BMD)及血清可溶性Klotho(soluble Klotho,sKlotho)蛋白的影响。方法选取自2019年6月至2022年5月于安徽医科大学第二附属医院行tPTx+AT患者86例,收集患者术前人口学特征,术前及术后第5天、术后1个月、术后3个月、术后6个月、术后12个月及术后24个月的血清校正钙、磷、全段甲状旁腺激素(intact parathyroid hormone,iPTH)、碱性磷酸酶(alkaline phosphatase,ALP)、成纤维细胞生长因子23(fibroblast growth factor 23,FGF23)及sKlotho蛋白,双能X线吸收法测量术前及术后(3个月、6个月、12个月及24个月)腰椎L1-L4骨密度。观察tPTx+AT术前及术后FGF23、sKlotho蛋白及骨密度的变化。结果86例患者均手术成功,术后临床症状如骨痛、皮肤瘙痒等明显改善;术后血钙、磷、iPTH、ALP及FGF23较术前均明显下降。血sKlotho在术后第5天时较术前显著下降,术后1个月时sKlotho水平较术前升高约24.5%,此后sKlotho趋于稳定。术后腰椎L1-L4骨密度增加,至术后12个月最高。进一步分析显示,透析龄、SHPT持续时间、ALP、iPTH及FGF23与术前腰椎L1-L4 Z值呈负相关,sKlotho与术前腰椎L1-L4 Z值呈正相关。结论tPTx+AT可显著改善SHPT患者临床症状,调节钙磷代谢平衡,增加sKlotho、降低FGF23水平,是提高骨密度的有效治疗手段。ObjectiveTo investigate the impact of total parathyroidectomy with autotransplantation(tPTx+AT)on bone mineral density and serum soluble Klotho(sKlotho)level in patients with secondary hyperparathyroidism(SHPT).MethodsA total of 86 patients undergoing tPTx+AT in the Second Affiliated Hospital of Anhui Medical University from June 2019 to May 2022 were recruited in this study.Their demographic characteristics were collected before surgery,along with serum levels of corrected calcium,phosphorus,intact parathyroid hormone(iPTH),alkaline phosphatase(ALP),fibroblast growth factor 23(FGF23),and sKlotho before and at 5 d,and 1,3,6,12 and 24 months after surgery.Dual energy X-ray absorptiometry was used to determine the BMD values of the lumbar spine L1-L4 before surgery and at 3,6,12 and 24 months after surgery.The changes in BMD and serum FGF23 and sKlotho levels before and after tPTx+AT were observed.ResultsSurgical treatment was successfully completed in all 86 patients,with their clinical symptoms such as bone pain and skin itching significantly improved postoperatively,and markedly decreased serum calcium,phosphorus,iPTH,ALP and FGF23 levels.The sKlotho level was significantly lower at 5 d postoperatively than that preoperatively,with that at 1 month after surgery increased by approximately 24.5%than the preoperative level,and then the level was in a stable trend.The BMD values at the lumbar spine L1-L4 were increased postoperatively,and reached the highest levels at 12 months postoperatively.Further analyses showed that dialysis vintage,duration of SHPT,and ALP,iPTH and FGF23 levels were negatively correlated with the Z-scores of the lumbar spine L1-L4,while sKlotho level was positively correlated with the Z-scores.ConclusiontPTx+AT can significantly improve the clinical symptoms of SHPT patients,regulate the balance of calcium and phosphorus metabolism,increase sKlotho level and reduce FGF23 level.It is an effective method to improve BMD.

关 键 词：KLOTHO FGF23 骨密度 甲状旁腺全切+自体移植术 

分 类 号：R322.71[医药卫生—人体解剖和组织胚胎学] R581.1[医药卫生—基础医学] R643