甲状旁腺切除对尿毒症继发甲状旁腺功能亢进患者贫血和心功能的影响

Effect of parathyroidectomy on anemia and cardiac function in uremic patients with secondary hyperparathyroidism

目的探讨甲状旁腺全切（PTX）加前臂种植术对尿毒症继发性甲状旁腺功能亢进（SHPT）患者贫血及心功能的影响。方法回顾性分析浙江大学附属第一医院2010年10月至2015年12月接受甲状旁腺全切＋前臂种植术的130例尿毒症患者的临床资料，比较手术前后贫血、超声心动图指标等变化。根据术前是否存在左心室肥厚（LVH）分为LVH组和非LVH组，比较两组患者术前及术后1年超声心动图指标变化。结果与术前组相比，术后3个月组、1年组患者血红蛋白、红细胞比容显著升高，红细胞生成素用量显著减少（均P〈0．01）。与术前组相比，术后1年组患者干体重显著增加，心脏超声指标左室舒张末内径（LVDd）、室间隔舒张末厚度（IVSd）、左室后壁舒张末厚度（LVPWd）、室间隔收缩期厚度（IVSs）、左室收缩期内径（LVDs）、左心室心肌重量（LVM）、左心室心肌重量指数（LVMI）显著下降（均P〈0．05）。LVH组患者术后1年组LVDs、LVDd、LVPWd、LVM、LVMI、1VSs均较术前组显著下降（均P〈0．05）；非LVH组患者术后1年组仅IVSs较术前组下降（P〈0．05）。结论PTX加前臂移植术是难治性SHPT有效的治疗手段，能明显改善贫血及左心室结构和功能，尤其对于术前存在左心室肥厚的患者。

Objective To explore the effect of total parathyroidectomy （PTX） with forearm autograft on the anemia and cardiac function in uremic patients with secondary hyperparathyroidism （SHPT）. Methods The clinical data of 130 uremic patients who received PTX with forearm autograft in the First Affiliated Hospital of Zhejiang University from October 2010 to December 2015 were retrospectively analyzed. The changes of anemia and echocardiogram before and after operation were compared. According to the presence of left ventricular hypertrophy （LVH） before operation, the patients were divided into LVH group and non-LVH group. Echocardiographic indexes before and one year after operation of the two groups were compared. Results （1） Three months and one year after operation, hemoglobin and hematocrit increased while erythropoietin average usage decreased significantly （P 〈 0.01）. （2） Compared with preoperative period, the dry weight was significantly increased one year after operation, and the cardiac function indexes including left ventricular end diastolic diameter （LVDd）, interventricular septum end diastolic thickness （IVSd）, left ventricular posterior wall end diastolic thickness （LVPWd）, interventricular septum systolic thickness （IVSs）, left ventricular systolic diameter （LVDs）, left ventricular myocardial mass （LVM）, and left ventricular myocardial mass index （LVMI） decreased significantly （P 〈 0.05）. （3） In the non-LVH group, only IVSs decreased one year after operation （P 〈 0.05）. In the LVH group, LVDs, LVDd, LVPWd, LVM, LVMI and IVSs were decreased significantly one year after operation than those in preoperative period （P 〈 0.05）. Conclusions PTX with forearm autograft is an effective treatment for uremic patients with SHPT significantly improving anemia and left ventricular structure and function, especially for patients with ventricular hypertrophy in preoperative.