肾移植术后继发性甲状旁腺功能亢进的临床分析

Clinical analysis of secondary hyperparathyroidism after renal transplantation

目的研究肾移植术后合并甲状旁腺功能亢进的受者血清钙、磷代谢及免疫反应性甲状旁腺激素(iPTH)水平的变化趋势,探讨治疗方式的选择。方法回顾性分析2012年1月至2014年6月在解放军第三〇九医院全军器官移植研究所泌尿外科因尿毒症行肾移植、且术前并发继发性甲状旁腺功能亢进(SHPT)、术后移植肾功能恢复至估算肾小球滤过率(eGFR)>60 mL·min^(-1)·(1.73 m^2)^(-1)的受者资料。共179例受者纳入研究,平均年龄(34±6)岁(18~61岁),术前慢性肾脏病分级均为5级。肾移植术后常规应用骨化三醇治疗(0.25μg,1次/d),维持正常血清钙、磷水平。记录肾移植前后受者血清钙、磷及iPTH水平。采用单因素重复测量资料方差分析比较肾移植前和移植后1周、1个月、6个月、12个月和24个月受者血清钙、磷、iPTH水平,采用χ~2检验比较低磷血症和高钙血症发生率以及iPTH分布情况。结果肾移植术后1个月受者血清钙上升至稳定期,同时血清磷下降至稳定期;术后6个月高钙血症和低磷血症发生率最高,分别为8.4%(15/179)和9.5%(17/179)。术后1~6个月受者iPTH下降明显,随后无明显变化,术后24个月仅有27%(48/179)的受者iPTH水平降至完全正常。结论尿毒症患者行肾移植术后,SHPT均有所缓解,但大部分无法恢复至正常水平,术后需要进行积极的针对性治疗。

Objective To explore the calcium-phosphorus metabolism and variation trend of immunoreactive parathyroid hormone（ iPTH） of renal transplantation recipients after transplantation,and correct choice of treatment. Methods We retrospectively analyzed the clinical data of 179 recipients who got renal transplantation because of uremia between January 2012 to June 2014 in 309 th Hospital of Chinese People＇ s Liberation Army. All the recipients suffered from secondary hyperparathyroidism（ SHPT） and the renal function recoved to the estimated glomerular filtration rate（ e GFR） 60 mL·min^（-1）·（ 1. 73 m^2）^（-1） after transplantation. The average age of recipients was（ 34 ± 6） years（ 18-61 years） and chronic kidney disease function were graded as 5 T. Calcitriol（ 0. 25 μg/d） was regularly used after transplantation to maintain normal serum levels of calcium and phosphate. Indexes like e GFR and serum calcium,phosphate and iPTH of recipients before and after transplantation were recorded. One-way analysis of variance for repeated measurement data was used to compare serum calcium,phosphate and iPTH of recipients before and 1 week,1 month,6 months,12 months and 24 months after transplantation. Occurrence rate of hypophosphatemia and hypercalcemia,and distribution of iPTH were compared by Chi-square test. Results Serum calcium of recipients after renal transplantation rised to stationary phase,meanwhile,serum phosphate fallen to stationary phase. Recipients had the highest occurrence rate of hypophosphatemia（ 9. 5%,17/179）and hypercalcemia（ 8. 4%,15/179） 6 months after transplantation. Serum iPTH declined significantly during 1 to 6 months after transplantation with no significant change later. For serum iPTH,only 24%（ 48/179） of recipients returned to more normal levels 24 months after transplantation. Conclusions Symptoms of SHPT of uremia patients were all alleviated,but most of them couldn＇ t return to normal level,which needed active and specific treatment after renal transplantation.