不同方法治疗血透患者重度继发性甲状旁腺功能亢进对肾性贫血的影响

Effect of different treatments for severe secondary hyperparathyroidism in patients with hemodialysis on renal anemia

目的探讨及对比甲状旁腺全切术(T-PTX)及口服西那卡塞治疗血透患者重度继发性甲状旁腺功能亢进(SHPT)对肾性贫血的影响。方法回顾性分析2013年4月至2017年2月厦门大学附属成功医院血透合并重度SHPT患者临床资料,行T-PTX治疗者33例作为手术组,口服西那卡塞治疗者22例作为药物组,统计2组患者治疗前、治疗后第1、3、6、12个月的血清全段甲状旁腺素(iPTH)、碱性磷酸酶(ALP)、钙、磷、转铁蛋白饱和度(TSAT)、铁蛋白(SF)、C-反应蛋白(CRP)、白蛋白(Alb)及血红蛋白(Hb)、红细胞压积(Hct)、促红细胞生成素(EPO)用量等数据,并进行分析比较。结果手术组iPTH从治疗后第1个月开始,Hb、Hct和EPO用量从第6个月开始优于药物组,差异均有统计学意义(P<0.05);治疗后第12个月,手术组及药物组iPTH分别下降至(76.2±65.2)pg/mL和(638.9±233.8)pg/mL,Hb分别上升至(115.8±9.3)g/L和(109.5±5.4)g/L,EPO用量分别下降至(94.2±23.7)U/(kg·周)和(153.7±24.8)U/(kg·周),与组内治疗前以及组间比较差异均有统计学意义(P<0.05)。2组患者在治疗前及随访期内的铁贮指标存(TSAT、SF)、炎症指标(CRP)、营养指标(Alb)等组内、组间比较差异均无统计学意义(P>0.05)。手术组不良反应发生率高于药物组(P<0.01)。结论治疗血透患者重度SHPT对改善肾性贫血有益,且T-PTX在纠正SHPT及改善贫血方面较西那卡塞效果更好。

ObjectiveTo investigate the effect of total parathyroidectomy(T-PTX)for severe secondary hyperparathyroidism(SHPT)in patients with hemodialysis(HD)on renal anemia,and compared with those treated with Cinavalcet.MethodsThe patients who were maintenance HD with severe SHPT were enrolled into the retrospective case-control study,Thirty-three patients were underwent T-PTX(surgical group)and 22 patients received Cinavalcet treatment in the same period(drug group).The general data of patients in two groups and the changes of relevant indicators such as the serum levels of intact parathyroid hormone(iPTH),alkaline phosphatase(ALP),calcium(Ca),phosphorus(P),hemoglobin(Hb),red cell volume(Hct),transferrin saturation(TSAT),ferritin(SF),C-reactive protein(CRP),albumin(Alb)etc.were collected and recorded before and 1,3,6,12 months after therapy.The dosages of erythropoietin(EPO)at the same period were recorded too.These clinical data were analysis and comparison.ResultsCompared with the drug group,the serum level of iPTH in the operation group was obviously smaller from 1,,(P)ter 12 months of treatment,the serum iPTH in operation group and drug group rose to(76.2±65.2)pg/mL and(638.9±233.8)pg/mL respectively,the Hb increased to(115.8±9.3)g/L and(109.5±5.4)g/L respectively,and the dosages of EPO decreased to(94.2±23.7)U(/kg·week)and(153.7±24.8)U(/kg·week)respectively(P<0.05).The serum levels iron storage index(TSAT,SF),inflammation index(CRP),nutritional index(Alb)between the two groups were no significantly changed before therapy and during the follow-up period in statistics(P>0.05).The incidence of adverse reactions in the operation group was higher than that in the drug group(P<0.01)ConclusionThis study confirms that treatment of severe SHPT can improve the management of anemia in hemodialysis patients.T-PTX is more effective in correcting sever SHPT and improving anemia than Cinacalcet.