甲状旁腺切除对血液透析患者冠状动脉钙化和心血管事件的影响

The effect of parathyroidectomy on Hemodialysis patients' Coronary calcification and cardiovascular events

目的:观察甲状旁腺切除术(parathyroidectomy,PTX)对尿毒症并继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)患者冠状动脉钙化和心血管事件的影响。方法:将74例临床诊断SHPT明确的尿毒症患者,按照是否同意接受手术的意愿分为手术组和常规治疗组。手术组切除甲状旁腺,常规治疗组按KDOQI指南进行骨化三醇冲击治疗。结果:手术组1年后血清Ca、P、钙磷乘积(Ca×P)、i PTH、冠状动脉钙化积分均明显下降(P<0.05),同常规治疗组比较,差异有统计学意义(P<0.01)。常规治疗组1年后虽然甲状旁腺激素也明显下降,但冠状动脉钙化积分进展性升高,差异有统计学意义(P<0.05)。随访期间,手术组同常规治疗组心血管事件发生率比较,差异有统计学意义(P<0.05)。logistic回归分析显示冠状动脉钙化与血钙、磷、钙磷乘积显著相关,差异有统计学意义(P<0.01),而血磷、冠脉钙化是血液透析患者心血管事件发生的重要危险因素,差异有统计学意义(P<0.01)。结论:甲状旁腺切除术能改善SHPT患者冠状动脉钙化,降低心血管事件发生率。

Objective To observe the effect of parathyroidectomy on secondary hyperparathyroidism patients? Coronary calcificationand cardiovascular events. Method 74 cases of clinical diagnosis of SHPT clear uremic patients were divided into surgicalgroup and routine treatment group by whether willingness to agree to accept surgery. The surgical group was treated with the resectionof the parathyroid gland, and the routine treatment group was treated with the KDOQI guide for the treatment of calcitriol shocktherapy. Results The surgical group patients? Serum Ca,P,calcium - phosphorus product~,IPTH~,Coronary calcium score obviouslydecreased (P < 0. 05) after 1 year treatment. Compared to routine treatment group had significant difference. Although the routinetreatment group patients? parathyroid hormone also had obviously decreased (P < 0. 05 ) , but coronary calcium score advanced torise. During the follow - up period, there were significant differences in the incidence of cardiovascular events between the surgicalgroup and the conventional treatment group (P < 0. 05 ). Logistic regression analysis showed that coronary calcification associatedwith blood calcium, phosphorus, calcium - phosphorus product obviously ( P < 0. 01 ) , and Serum P, coronary calcification are therisk factors of hemodialysis patients? cardiovascular events (P <0. 01). Conclusion Parathyroidectomy can improve the coronarycalcification in patients with SHPT,and reduce the incidence of cardiovascular events.