甲状旁腺全切术对血清FGF-23及炎性因子的影响

Effects of parathyroidectomy on serum FGF-23 and inflammatory factors in patients with SHPT

目的分析继发性甲状旁腺功能亢进(secondary hyperpar hyroidism,SHPT)患者行甲状旁腺全切术(T-parathyroidectomy,T-PTX)前后血清成纤维细胞生长因子-23(fibroblast growth factor-23,FGF-23)及炎性因子的变化,并探讨其变化的意义。方法选取2011-01至2013-01武警总医院肾内科行T-PTX术成功的患者40例做为研究对象,术后均行普通血液透析治疗,排除血液透析滤过及灌流对实验的影响,收集其术前、术后1 d、1、3、6个月血清,对比不同时间点血清FGF23、全段甲状旁腺激素(iPTH)和血清钙、血磷、hs CRP检测结果。结果 (1)术后1 d及1、3、6个月血清FGF-23、iPTH、血清钙、血磷水平明显低于术前,差异有统计学意义(P<0.05);(2)术后1 d血清hs CRP水平较术前无统计学意义,术后1、3、6个月血清hs CRP水平[(2.64±1.32 vs 20.31±8.56)mg/L、(2.16±1.08 vs 20.31±8.56)mg/L、(1.38±0.17 vs 20.31±8.56)mg/L]明显低于术前的(11.72±5.21 vs 20.31±8.56)mg/L,差异有统计学意义(P<0.05)。结论 T-PTX可有效降低患者血清FGF23、PTH及炎性因子水平,纠正钙磷代谢紊乱,对减少远期心血管事件及骨矿物质代谢疾病有重要意义。

Objective To analyze the changes of serum fibroblast growth factor-23（ FGF-23） and inflammatory factors of secondary hyperparathyroidism（ SHPT） patients who had undergone total parathyroidectomy,and explore the significance of these changes. Methods Forty SHPT patients treated with T-PTX between January 2011 and January 2013 in the Department of Nephrology,Armed Police General Hospital,were enrolled in this study. Each patient was given hemodialysis. Serum FGF-23,parathyroid hormone（ PTH）,calcium（ Ca）,phosphorus（ P） and high sensitivity reactive protein（ hs CRP） obtained during the preoperative,postoperative and follow-up periods were collected and compared. Results（ 1） Serum levels of FGF-23,PTH,Ca,P,and hs CRP decreased significantly one day,one month,three months and 6 months after PTX（ P〈0. 05）.（ 2） Levels of serum hs CRP decreased one day after PTX,but not significantly. Serum hs CRP was（ 20. 31 ± 8. 56） mg/L before PTX,and was（ 11. 72 ± 5. 21） mg/L,（ 2. 64 ± 1. 32）mg/L,and（ 2. 16 ± 1. 08） mg/L respectively 1 month,3 months,and 6 months after PTX（ P〈0. 05）. Conclusions T-PTX can effectively reduce the levels of serum FGF-23,PTH and inflammatory factors,correct the disturbance of Ca and P metabolism,and reduce the incidence of long-term cardiovascular events and bone metabolism diseases.