尿毒症继发性甲状旁腺机能亢进症26例报道

Hyperparathyriodism secondary to uraemic patients Report of 26 cases

目的了解尿毒症继发性甲状旁腺机能亢进症（SHPT）患者甲状旁腺（PT）的病理改变及其与临床表现的关系。方法分析SHPT患者的PT病理改变，比较不同病理改变间患者性别、年龄、透析龄、体重指数、血钙（Ca^2＋）、血磷（P^3-）、血清碱性磷酸酶（ALP）及全段甲状旁腺激素（iPTH）的差异。结果在26例SHPT患者的PT病理改变中，PT弥漫性增生11例（42．3％）、结节性增生6例（23．1％）、腺瘤9例（34．6％）。PT弥漫性增生患者的透析龄（70．54±46．69）个月，血Ca^2＋（2．37±0．19）mmol／L。PT结节样增生和腺瘤患者的透析龄（107．33±43．73）个月，血Ca^2＋（2．67±0．23）mmol／L。PT结节样增生和腺瘤患者的透析龄、血Ca^2＋明显高于PT弥漫性增生的患者（P〈0.05）。结论SHPT的PT以弥漫性增生为主；PT结节样增生和腺瘤患者的透析龄、血Ca^2＋明显高于PT弥漫性增生患者。

Objective To investigate the relationship between histopathological changes of parathyroid （PT） and clinical manifestation of secondary hyperparathyroidism （SHPT） in uraemia pa dents. Method To observe the histopathology of PT, and analyze the relationship betweea histopathologic types of PT, and clinical gender, age, duration of dialysis, underling disease, body mass index,metabolism of calcium and phosphorus,et al. Results In 26 patients,diffuse hyperplasia （DH） were found in 11 cases （42. 3%）, nodular hyperplasia （NH） in 6 cases （23. 1%） and adenoma （A） in 9 cases （34. 6%）. In DH group： duration of dialysis was （70. 54±46.69） monthes, Ca^2＋ （2. 37 ± 0. 19）mmol/L. In NH and A groups： duration of dialysis was 107.33 ± 43.73 monthes, Ca^2＋ （2. 67 ± 0. 23）mmol/L. The duration of dialysis and the level of serum total calcium （adjusted by serum albumin） in NH and A groups were higher than that in DH group （P〈0. 05）. Conclusions The majority of parathyroid lesions in SHPT are diffuse hyperplasia. The duration of dialysis and the level of serum total calcium in NH and A group were higher.