甲状旁腺切除对终末期肾病并继发性甲旁亢患者钙磷代谢的影响

Effect of parathyroidectomy on calcium and phosphorus metabolism in patients with end-stage renal disease and secondary hyperparathyroidism

目的:探讨甲状旁腺切除术(PTX)对终末期肾病合并继发性甲状旁腺功能亢进患者钙磷代谢的影响。方法:选取2015年1月至2016年3月在广州医科大学附属第二医院肾内科接受维持性血液透析或腹膜透析3个月以上的15例终末期肾病并继发性甲旁亢患者作为研究对象,均行PTX,其中全切1例、次全切除7例、全切加自体手臂移植术7例。术前,术后1 d、1、6、12个月检测血清全段甲状旁腺素(i PTH)、血钙、血磷、白蛋白及碱性磷酸酶(ALP)水平,观察术后症状是否缓解,随访1年观察是否复发。结果:15例患者手术均取得成功,围手术期无死亡发生,术后第一天患者骨痛或瘙痒等症状缓解,术后各时相点i PTH、血钙、血磷、碱性磷酸酶水平较术前下降(P<0.05)。12例患者术后出现低钙血症,经积极静脉补钙后1周症状内得到有效控制。术后6个月1例行次全切除的患者出现复发。结论:甲状旁腺切除术可以显著降低终末期肾病合并继发性甲旁亢患者的高i PTH水平,有效改善患者血清钙磷代谢,骨痛和瘙痒等症状。

Objective：To investigate the effect of parathyroidectomy （PTX） on calcium and phosphorus metabolism in patients with end-stage renal disease （ESRD） and secondary hyperparathyroidism （SHPD）. Methods： Fifteen patients with ESRD and SHPD, who received maintenance hemodialysis or peritoneal dialysis for more than 3 months between January 2015 and March 2016 at the Department of Nephrology, the Second Affiliated Hospital of Guangzhou Medical University, were included as the subjects in the study. All patients underwent PTX, including 1 case of total PTX （TPTX）, 7 of subtotal PTX （SPTX）, and 7 of TPTX and autologous arm transplantation （AT）. The serum levels of intact parathyroid hormone （ iPTH）, calcium, phosphorus, albumin and alkaline phosphatase （ALP） were determined at the baseline, and at ld, 1, 6 and 12 months after the operation. The relief of postoperative symptoms was determined. All patients were followed up for 1 year to determine the recurrence. Results： Fifteen patients underwent successful operation, and no perioperative deaths occurred. The symptoms of bone pain or itching were relieved at ld after the operation. The levels of iPTH, serum calcium, serum phosphorus and alkaline phosphatase at different time points after the operation were decreased compared with those at the baseline （P〈0.05）. Postoperative hypocalcemia occurred in 12 patie1nts （ 80%）, and it was effectively controlled at 1 week after actively intravenous calcium supplement. Therecurrence occurred in 1 patient underwent TPTX at 6 months after the operation. Conclusion： PTX can significantly reduce the high levels of iPTH in patients with ESRD and SHPD, and effectively improve the serum calcium and phosphorus metabolism, and symptoms of bone pain and itching.