甲状旁腺次全切除术和西那卡塞口服对难治性甲状旁腺功能亢进患者骨代谢的影响

Effect of subtotal parathyroidectomy and oral administration of cinacalcet on bone metabolism in refractory hyperparathyroidism patients

目的:观察甲状旁腺次全切除术(near total parathyroidectomy,NPTX)治疗尿毒症导致的继发性甲状旁腺功能亢进患者骨密度的临床疗效。方法:采用随机对照法选择我院尿毒症引起的继发性甲状旁腺功能亢进患者60例,设手术组和对照组,手术组使用NPTX,对照组口服西那卡塞,分别监测治疗前、后骨密度值,全段的甲状旁腺激素(intact parathyroid hormone, i PTH)、血钙、血磷和碱性磷酸酶(alkaline phosphatase, ALP)指标,以评估疗效。结果:手术组血磷、iPTH,ALP、骨密度明显改善(均P<0.05),对照组血钙、血磷、iPTH均有明显改善(均P<0.05),ALP治疗前、后无明显差异。手术组较对照组血磷、iPTH、ALP、骨密度改善程度更好(P<0.05),血钙降低手术组与对照组无明显差异。手术组临床骨痛消失。结论:NPTX安全,能有效治疗尿毒症导致的继发性甲状旁腺功能亢进患者,有效控制体内血钙、血磷、i PTH水平,提高骨密度,缓解骨痛症状,明显改善患者的生活质量。

Objective To study the effect of subtotal parathyroidectomy in uremia patients with secondary hyperparathyroidism. Methods A total of 60 uremia patients with hyperparathyroidism were enrolled and were divided into surgery group and non-surgery group. Subtotal thyroidectomy was performed in surgery group, and the non-surgery group received oral administration of cinacalcet. Clinical data were collected including gender, age, dialysis, as well as levels of serum calcium (Ca), phosphatus (P), intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), and bone mineral density. All these indicators were detected before and after treatment. Results The levels of Ca, P, iPTH were improved both in surgery group and non-surgery group, and were more obvious in the surgery group. The ALP level was improved only in surgery group. Conclusions Subtotal parathyroidectomy can improve the levels of Ca, P, iPTH, ALP, bone mineral density and releasing bone pain.