甲状旁腺切除术纠正继发性甲状旁腺功能亢进改善肾性贫血的临床研究

Study on improvement of renal anemia after parathyroidectomy for treatment of secondary hyperparathyroidism

目的探讨甲状旁腺切除术(PTX)纠正重度继发性甲状旁腺功能亢进(SHPT)对难治性肾性贫血的影响。方法选取并发重度SHPT及难治性肾性贫血的维持性血液透析(MHD)患者33例,均为药物治疗无效后行PTX。观察术前、术后第1、3、6、12个月时患者血清全段甲状旁腺激素(iPTH)、钙(Ca)、磷(P)、血红蛋白(Hb)及红细胞压积(Hct)、重组人促红细胞生成素(rHuEPO)用量、血清铁蛋白(SF)、转铁蛋白饱和度(TSAT)、血清白蛋白(ALB)、C反应蛋白(CRP)及Kt/V等指标的变化情况。结果与术前相化,PTX术后1月血清iPTH、Ca、P显著下降(P<0.05);术后3月开始,贫血明显改善,血Hb、Hct显著升高(P<0.05);术后6月rHuEPO用量显著减少(P<0.05)。PTX前后SF、TSAT、ALB、CRP及Kt/V等指标均无显著改变(P>0.05)。结论采用PTX纠正SHPT可显著改善MHD患者的肾性贫血,同时改善rHuEPO抵抗,提示重度SHPT是影响肾性贫血及rHuEPO疗效的一个重要因素。

Objective To evaluate the effects of parathyroidectomy （PTX） on renal anemia in maintenance hemodialysis （MHD） patients with severe secondary hyperparathyroidism （SHPT）. Methods Thirty -three MHD patients with severe SHPT were enrolled, all these patients were underwent PTX after failure of medical therapy. The iPTH, Ca, P and anemia levels, iron homeostasis, dose of rHuEPO requirement and nutritional state were assessed before and 1,3,6,12 months after PTX, and Kt/V were calculated. Results The levels of iPTH, Ca, P were decreased significantly from 1 month after PTX. The hemoglobin level and hematocrit showed a significant increase at 3 months after FIX, and rHuEPO dose requirement decreased remarkablely from 6 months after PTX. There was no statistically significant difference in serum iron and transferfin saturation, CRP, and the adequacy of dialysis before and after PTX. Conclusion We conclude that PTX can improve renal anemia and decrease the resistance to rHuEPO therapy at the same time in MHD patients with severe SHPT.