慢性肾衰竭继发性甲状旁腺功能亢进合并退缩人综合征的临床分析

Clinical analysis of Shrinking man syndrome resulted from secondary hyperparathyroidism

目的分析慢性肾衰竭继发性甲状旁腺功能亢进(SHPT)合并退缩人综合征(SMS)患者的临床特点及相关性因素。方法选取在我院肾内科住院并行甲状旁腺全切术的SHPT患者70例为研究对象,按身高较发病前是否缩短分为退缩组和非退缩组,收集一般资料,所有患者均行甲状旁腺全切术,检测患者血甲状旁腺激素(PTH)、血磷(P)、血钙(Ca)、碱性磷酸酶(ALP)、成纤维细胞生长因子-23(FGF-23)水平,分析合并SMS的影响因素。结果 70例SHPT患者中共有50例合并SMS,发生率为71.4%;退缩组患者透析龄(t=8.368,P=0.000)、血PTH(t=5.814,P=0.000)、血P(t=3.470,P=0.001)、血ALP(t=7.985,P=0.000)、血FGF-23(t=2.128,P=0.037)水平明显高于非退缩组;相关性分析表明,退缩组患者身高缩短与透析龄(r=0.421,P=0.002)、PTH(r=0.418,P=0.003)、ALP(r=0.596,P=0.000)、FGF-23水平(r=0.875,P=0.000)均呈正相关,与血Ca呈负相关(r=-0.394,P=0.005),而与血P无相关性(r=0.029,P=0.061);术后病理证实SMS患者甲状旁腺组织增生以结节性增生为主。结论 SHPT合并SMS的发生主要与透析龄、血PTH、ALP、Ca及FGF-23水平相关。

Objective To analysis the clinical features and related affective factors of Shrinking man syndrome （SMS） in Secondary hyperparathyroidism （SHPT） patients. Methods Seventy SHPT patients were selected as research objects and all accepted parathyroidectomy. All of the patients were divided into shrinking group and control group according to whether their height shortened. The general information was collected, serum parathyroid hormone （PTH）, phosphorus （P）, calcium （Ca）, alkaline phosphatase （ALP） and fibroblast growth factor-23 （FGF-23） detected, then analysis the affective factors of SMS. Results There were 50 patients with SHPT associated with SMS, the rate was 71.4%. Compared with control group, the dialysis ages （t=8.368, P=0.000）, PTH （t=5.814, P=0.000）, P （t=3.470, P=0.001）, ALP （t=7.985, P=0.000）, FGF-23 （t=2.128, P=0.037） in SMS group were significantly higher. The height shorten of SMS patients was positively correlated with dialysis ages （r=0.421, P=0.002）, PTH （r=0.418, P=0.003）, ALP （r=0.596, P=0.000） and FGF-23 （r=0.875, P=0.000）, negatively correlated with serum Ca （r=-0.394, P=0.005）, and the height shorten had no correlation with serum P （r=0.029, P=0.061）. In addition, pathology analysis showed that in SMS patients the hyperplasia form of parathyroid glands was mostly nodular hyperplasia. Conclusion The affective factors of SMS in SHPT patients are dialysis ages, serum PTH, ALP, Ca and FGF-23.