甲状旁腺切除术对维持性血液透析患者肾性贫血及促红细胞生成素剂量的影响

Effect of parathyroidectomy on renal anemia and erythropoietin dose in maintenance hemodialysis patients with secondary hyperparathyroidism

目的评价甲状旁腺切除术对维持性血液透析患者肾性贫血及促红细胞生成素剂量的影响。方法回顾性分析接受甲状旁腺全切加部分前臂自体移植术的患者27例,观察术前及术后第1,3,6,12个月时血红蛋白(Hb)、红细胞比积(Hct)、血清铁蛋白(SF)、C反应蛋白(CRP)、白蛋白(Alb)、血清钙(Ca)、磷(P)、碱性磷酸酶(ALP)、血清全段甲状旁腺激素(iPTH)和尿素清除指数(Kt/V)以及手术并发症等,并记录各时间段患者促红细胞生成素用量等数据。结果 27例患者甲状旁腺切除(PTX)术后,iPTH水平自第1月起即显著下降至理想水平(P<0.05),并在随后的12个月随访期间内,处于稳定状态。Hb及Hct在术后第3月开始逐渐上升,至术后12月时,分别为(119.2±8.7)g/L和(35.0±3.9)%,与术前比较差异有统计学意义(P<0.05)。术后EPO用量显著减少,至术后12月时,减少至(6 317.5±1 327.4)U/周,与术前比较差异有统计学意义(P<0.05)。结论继发性甲状旁腺功能亢进是导致慢性肾衰竭患者促红细胞生成素抵抗的重要因素之一,PTX可迅速降低iPTH水平并显著改善肾性贫血、减少促红细胞生成素用量。

Objective To evaluate the effects of parathyroidectomy（PTX） on renal anemia and erythropoietin dose in maintenance hemodialysis（MHD） patients. Methods Retrospective analysis was used for 27 patients with maintenance hemodialysis who underwent total PTX ＋ partial forearm autotransplantation. The hemoglobin（Hb） levels, hematocrit（ Hct）, serum ferritin（ SF）, C-reactive protein （ CRP）, albumin （ Alb）, serum calcium （ Ca）, phosphorus （ P）, alkaline phosphatase （ALP）, intact parathyroidhormone （ iPTH ）, urea clearance index（Kt/V） and erythropoietin dose were assessed before and at month 1,3,6,12 after surgery. Results The iPTH level was decreased significantly to the ideal state from month 1 after PTX（P 〈0.05） ,and remained the stable state in the subsequent 12 months. Hb and Hct levels gradually increased from month 3, and rose to （ 119.2 ~ 8.7 ） g/L and （ 35.0 -＋ 3.9 ） % at month 12, respectively（P 〈 0.05 ）. EPO dose decreased from （9 986.6 ＋ 1 732.2） U/week before operation to （6 317.5 ＋ 1 327.4）U/week at month 12 （P 〈 O. 05）. Conclusion Secondary hyperparathyroidism is an important cause of EPO resistance in MHD patients. PTX can decrease iPTH levels and improve the renal anemia and decrease requirements of erythropoietin.