血液透析继发性甲状旁腺功能亢进患者行甲状旁腺全切术后钙磷代谢水平变化及发生心血管不良事件的危险因素分析  

Changes of Postoperative Calcium-phosphorus Metabolism and Risk Factors of Cardiovascular Adverse Events in Hemodialysis Patients with Secondary Hyperparathyroidism Undergoing Total Parathyroidectomy

作　　者：吕燕 程新华 王霞[2] LYU Yan;CHENG Xinhua;WANG Xia(Department of Hemodialysis,Nanchang First Hospital,Nanchang 330008,China;不详)

机构地区：[1]南昌市第一医院血液透析室,江西南昌330008 [2]南昌大学第一附属医院肾内科,江西南昌330006

出　　处：《中国医学创新》2024年第29期149-153,共5页Medical Innovation of China

摘　　要：目的:分析血液透析继发性甲状旁腺功能亢进患者行甲状旁腺全切术后钙磷代谢水平变化及发生心血管不良事件的危险因素。方法:选取南昌市第一医院2020年1月—2022年8月收治的80例血液透析继发性甲状旁腺功能亢进患者资料,所有患者均接受甲状旁腺全切术治疗,比较术前、术后1个月、术后1年时的钙磷代谢指标[全段甲状旁腺激素(iPTH)、血钙(Ca)、血磷(P)]变化,根据术后1年内不良心血管事件发生情况分为良好组和异常组,比较两组临床资料,并对有差异性单因素进行logistic回归分析。结果:患者术前、术后1个月、术后1年的iPTH、Ca、P均呈下降趋势,差异均有统计学意义(P<0.05),术后1个月、1年上述指标均低于术前,差异均有统计学意义(P<0.05);术后1年内共22例患者出现心血管不良事件,发生率为27.50%;异常组年龄、透析龄均大于良好组,术前iPTH、Ca、P、收缩压、低密度脂蛋白胆固醇均高于良好组,差异均有统计学意义(P<0.05);logistic回归分析显示,透析龄、术前iPTH、收缩压、低密度脂蛋白胆固醇为发生心血管不良事件的危险因素(P<0.05)。结论:血液透析继发性甲状旁腺功能亢进患者行甲状旁腺全切术后钙磷代谢功能明显改善,透析龄、术前iPTH、收缩压、低密度脂蛋白胆固醇是患者术后发生心血管不良事件的影响因素,临床应针对存在上述情况的患者定期监测,保证良好预后。Objective:To analyze the changes of postoperative calcium-phosphorus metabolism and the risk factors of cardiovascular adverse events in hemodialysis patients with secondary hyperparathyroidism undergoing total parathyroidectomy.Method:The data of 80 hemodialysis patients with secondary hyperparathyroidism in Nanchang First Hospital were selected from January 2020 to August 2022.All patients were treated with total parathyroidectomy.The changes in calcium-phosphorus metabolism indicators[intact parathyroid hormone(iPTH),serum calcium(Ca),serum phosphorus(P)]were compared before surgery and at 1 month and 1 year after surgery.According to the occurrence of adverse cardiovascular events within 1 year after surgery,they were classified into good group and abnormal group.The clinical data of the two groups were compared,and logistic regression analysis was performed on the single factors with differences.Result:The iPTH,Ca and P of patients before surgery and at 1 month and 1 year after surgery showed downward trends(P<0.05),and the above indicators at 1 month and 1 year after surgery were lower than those before surgery(P<0.05).There were 22 patients with cardiovascular adverse events within 1 year after surgery,with an incidence rate of 27.50%.The age and dialysis age in abnormal group were older than those in good group,and the preoperative iPTH,Ca,P,systolic blood pressure and low-density lipoprotein cholesterol were higher than those in good group(P<0.05).logistic regression analysis showed that dialysis age,preoperative iPTH,systolic blood pressure and low-density lipoprotein cholesterol were risk factors of cardiovascular adverse events(P<0.05).Conclusion:The calcium-phosphorus metabolism function of hemodialysis patients with secondary hyperparathyroidism after total parathyroidectomy is significantly improved.Dialysis age,preoperative iPTH,systolic blood pressure,and low-density lipoprotein cholesterol were the influencing factors of postoperative cardiovascular adverse events.Clinically,it is necessary to p

关 键 词：血液透析继发性甲状旁腺功能亢进 甲状旁腺全切术 钙磷代谢 心血管不良事件 影响因素 

分 类 号：R653[医药卫生—外科学]