甲状旁腺切除术对维持性血液透析患者肾性贫血的影响

Effect of Total Parathyroidectomy with Forearm Auto-transplantation for Renal Anemia in Patients on Maintenance Hemodialysis

目的探讨甲状旁腺全切术加部分前臂自体移植术(parathyroidectomy+foreary auto-transplantation,PTX+FAT)对伴有重度继发性甲状旁腺功能亢进(SHPT)及难治性肾性贫血的维持性血液透析患者肾性贫血的疗效。方法选取伴有重度SHPT及难治性肾性贫血的维持性血液透析患者30例,观察术前、术后第3、6、12个月时患者的血清全段甲状旁腺素(iPTH)、钙(Ca)、磷(P)、血红蛋白(Hb)、红细胞压积(Hct)、血清铁蛋白(SF)、转铁蛋白饱和度(TSAT)、血清白蛋白(Alb)、KT/V等指标变化,并记录各时间段患者促红细胞生成素(rHuEPO)用量等数据。结果与术前相化,PTX+FAT术后3个月血清iPTH、Ca、P下降;术后3个月开始,贫血明显改善,血Hb、Hct显著升高,差异有统计学意义(P<0.05);术后6个月rHuEPO用量显著减少,差异有统计学意义(P<0.05)。PTX前后SF、TSAT、ALB、CRP及Kt/V等指标均无显著改变,差异无统计学意义(P>0.05)。结论重度SHPT血液透析患者在PTX+FAT术后可迅速降低iPTH水平并显著改善肾性贫血、减少促红细胞生成素用量,提示SHPT是引起rHuEPO抵抗的一个重要因素,纠正SHPT有利于维持性血液透析患者肾性贫血的改善。

Objective To explore the efficacy of total parathyroidectomy with forearm auto-transplantation （PTX ＋ FAT） for renal anemia in patients with severe secondary hyperparathyroidism （SHPT）and refractory renal anemia who were on mainte- nance hemodialysis. Methods Thirty patients on maintenance hemodialysis accompanied by severe SHPT and refractory renal a- nemia were enrolled in this study. The serum levels of thymidotropin （ iPTH ）, calcium （ Ca ）, phosphorus （ P ）, hemoglobin （ Hb ）, hematocrit （Hct） , serum ferritin （ SF ） , transferrin saturation （ TSAT ） , serum albumin （ Alb ） , KT/V and other indicators were ob- served and recorded before and 3,6,12 months after operations. And the dosages of erythropoietin （rHuEPO）during each period were recorded. Results The serum levels of iPTH, Ca and P decreased 3 months after operations. Anemia improved and the levels of Hb and Hct increased significantly from the 3rd month after operation（ P 〈 0. 05 ）. And the dosage of rHuEPO decreased signifi- cantly from the 6th month after operations. Changes of the serum levels of SF,TSAT,ALB ,CRP and KT/V did not show statistical significance （ P 〉 0. 05 ）. Conclusion After the operations, levels of iPTH and dosage of erythropoietin decreased and anemia im- proved in patients with severe SHPT, suggesting that SHPT could be an important factor of rHuEPO resistance. And patients on ma- intenance hemodialysis might benefit from treatment for SHPT.