甲状旁腺切除对尿毒症继发性甲状旁腺功能亢进症患者营养状态的影响

Effects of parathyroidectomy on nutritional status in uremic patients with secondary hyperparathyroidism

目的观察甲状旁腺切除对尿毒症继发性甲状旁腺功能亢进症(Secondary Hyperparathyroidism,SHPT)患者营养状态的影响。方法选取30例尿毒症继发性甲状旁腺功能亢进患者,手术切除甲状旁腺,于手术前及手术1年后使用改良整体主观评估法(modified quantitative subjective global assessment,MQSGA)评估患者营养状况,测量肱三头肌皮褶(TSF)厚度、上臂中部周径(MAC),根据公式计算上臂中部肌肉周径(MAMC);并比较手术前及手术1年后血清全段甲状旁腺激素(iPTH)、血清磷(P)、钙磷乘积(Ca×P)、血清钙(Ca)、血红蛋白(Hb)、红细胞压积(Hct)、白蛋白(Alb)、转铁蛋白(TF)水平的变化。结果与手术前比较,手术切除甲状旁腺1年后,患者血iPTH、血磷、钙磷乘积、血钙水平均明显下降(t=-8.78、-4.704、-5.771、-3.990,均P<0.01);Hb、Hct、Alb水平均明显升高,手术前后TF比较差异无统计学意义(P>0.05);MQSGA评分(8.93±2.12比11.1±4.31,t=-2.652,P=0.013)明显下降,TSF(t=2.257,P=0.035)、MAMC(t=2.536,P=0.020)明显增加。结论甲状旁腺切除能有效改善尿毒症继发甲状旁腺功能亢进症患者的营养状态。

Objective To observe the effect of parathyroidectomy on nutrition status in uremic patients with secondary hyperparathyroidism.Methods Thirty uremic patients with secondary hyperparathyroidism were treated with parathyroidectomy.Before parathyroidectomy and after the surgery for one year,nutrition status was evaluated by modified quantitative subjective global assessment （MQSGA）,triceps skin fold （TSF）,mid arm circumference （MAC）,and mid arm muscle circumference （MAMC） calculated from a formula.Serum parathyroid （iPTH）,phosphorus （P）,calcium and phosphorus product （Ca × P）,calcium （Ca）,Alb,Hb,Hct,transferring （TF） were measured before parathyroidectomy and after the surgery for one year.Results After parathyroidectomy for one year,serum iPTH （t=-8.780,P=0.000）,phosphorus （t=-4.704,P=0.000）,Ca×P （t=-5.771,P=0.000） and Ca （t=-3.990,P=0.001） decreased,as compared with those before parathyroidectomy.In addition,Hb,Hct and Alb increased,MQSGA score decreased （t=-2.652,P=0.013）,TSF （t=2.257,P=0.035） and MAMC （t=2.536,P=0.020） increased.Conclusion Nutrition status improved after parathyroidectomy in uremic patients with secondary hyperparathyroidism.