甲状旁腺切除对血液透析患者心血管钙化影响的初步探讨

I mpact of parathyroidectomy on cardiovascular calcification in maintenance hemodialysis patients

目的观察甲状旁腺切除术(PTX)对伴有继发性甲状旁腺功能亢进症(Secondary Hyperparathyroidism,SHPT)的血液透析患者钙磷代谢以及动脉钙化、动脉僵硬度情况的影响。方法选取21例有继发性甲状旁腺功能亢进的血液透析患者,行甲状旁腺切除术,对患者术前、术后1年应用多层螺旋CT检测冠状动脉钙化积分,并测臂踝脉搏波传导速度(ba PWV),同时将患者术前、术后1年的血钙、血磷、钙磷乘积、PTH等指标进行比较。结果与术前比较,术后1年患者冠状动脉钙化积分有明显减低(P=0.0236),左右两侧肢体臂踝脉搏波传导速度(ba PWV)平均值减少(P=0.0034,P=0.0012),差异性有统计学意义;术后血钙、血磷、钙磷乘积、PTH水平均明显降低,差异性有统计学意义(P分别为0.0004,0.0002,0.0000,0.0000)。结论甲状旁腺切除术(p Tx)能纠正钙磷代谢紊乱,减轻动脉钙化程度,改善动脉僵硬度。

Objective To observe the impact of parathyroidectomy （PTX） on calcium and phosphorus metabolism, arterial calcification and arterial stiffness in maintenance hemodialysis （MHD） patients complicated with secondary hyperparathyroidism （SHPT）. Methods A total of 21 MHD patients with SHPT were subjected to PTX. Their coronary artery calcification score based on the multi-slice spiral CT images, brachial-ankle pulse wave velocity （baPWV）, serum calcium, phosphorus, calcium-phosphorus product, and serum PTH were compared before PTX and after PTX for one year. Results After PTX for one year, coronary artery calcification score decreased significantly （P=0.0236）, so did the mean baPWVs of bilateral limbs （P=0.0034 and 0.0012 for left and right limbs, respectively）, as compared with those before PTX. Serum calcium, phosphorus, calcium-phosphorus product, and PTH also reduced after PTX （P=0.0004, 0.0002, 〈0.0001 and 〈0.0001, respectively）. Conclusions PTX improved calcium and phosphorus metabolism, and reduced arterial calcification and stiffness in MHD patients with SHPT.