甲状旁腺切除术对终末期肾病合并继发性甲状旁腺功能亢进患者冠状动脉钙化及钙磷代谢的影响

Effects of Parathyroidectomy on Coronary Artery Calcification and Calcium and Phosphorus Metabolism in Patients with End-stage Hyperparathyroidism Complicated by Secondary Hyperparathyroidism

目的探讨甲状旁腺切除术对终末期肾病(ESRD)合并继发性甲状旁腺功能亢进(SHPT)患者冠状动脉钙化(CAC)及钙磷代谢的影响。方法选取2006年1月—2016年2月择期行甲状旁腺切除术的300例ESRD合并SHPT患者的临床资料进行回顾性分析,并根据有无发生CAC分为CAC组210例和无CAC组90例。采用多因素Logistic回归分析影响ESRD合并SHPT患者发生CAC的独立危险因素,并比较所有患者术前、术后6和12个月的CAC积分及甲状腺旁腺激素(i PTH)、血钙、血磷、钙磷乘积、甘油三酯水平变化。结果透析时间长、CAC积分高是影响ESRD合并SHPT患者发生CAC的独立危险因素(P<0.05)。术后6和12个月,血钙、血磷、钙磷乘积、甘油三酯、i PTH水平及CAC积分均低于术前(P<0.05)。术后12个月,i PTH水平及CAC积分低于术后6个月(P<0.05)。结论甲状旁腺切除术可有效地改善ESRD合并SHPT患者钙磷代谢紊乱、降低i PTH水平,抑制CAC进展。

Objective To investigate effects of parathyroidectomy on coronary artery calcification（ CAC） and calcium and phosphorus metabolism in patients with end-stage renal disease（ ESRD） complicated by secondary hyperparathyroidism（ SHPT）. Methods Clinical data of 300 patients with ESRD complicated by SHPT undergoing selective parathyroidectomy admitted during January 2006 and February 2016 was retrospectively analyzed,and the patients were divided into CAC group（ n = 210） and non CAC group（ n = 90） according to whether or not having CAC. Multiple factor Logistic regression analysis was used to analyze independent risk factors affecting CAC pathogenesy in patients with ESRD complicated by SHPT,the CAC accumulated points and changes of immunoreactive parathyroid hormone（ IPTH）,blood calcium,blood phosphorus,calcium-phosphorus product and triglyceride levels before and in 6 and 12 months after operation were compared in all patients. Results Long dialysis time and high CAC accumulated points were independent risk factors affecting CAC pathogenesy in patients with ESRD complicated by SHPT（ P〈0. 05）. In 6 and 12 months after operation,blood calcium,blood phosphorus,calcium-phosphorus product,triglyceride and IPTH levels and accumulated points were significantly lower than those before operation（ P〈0. 05）. In 12 months after operation,values of IPTH level and CAC accumulated point were significantly lower than those in 6 months after operation（ P〈0. 05）. Conclusion Parathyroidectomy may effectively improve calcium and phosphorus metabolic disturbance,reduce IPTH level and inhibit CAC progression in patients with ESRD complicated by SHPT.