甲状旁腺全切+前臂移植术对继发严重甲状旁腺功能亢进患者微炎症和胰岛素抵抗的影响

Effect of parathyroidectomy on insulin resistance and microinflammatory status in uremic patients with secondary hyperparathyroidism

目的探讨甲状旁腺全切+前臂移植术(parathyroidectomy with forearm autograft,PTX+AT)对肾衰竭继发严重甲状旁腺功能亢进症(secondary hyperparathyroidism, SHPT)患者微炎症状态和胰岛素抵抗的影响。方法回顾性分析38例于2017年3月～2018年6月在广州市番禺中心医院行PTX+AT治疗的维持性腹膜透析、非糖尿病患者的临床资料,记录手术前后患者血全段甲状旁腺素(intact parathyroid hormone,iPTH)、磷(phosphorus,P)、总胆固醇(cholesterol,CH)、三酰甘油(triglyceride,TG)、低密度脂蛋白(low density lipoprotein,LDL)、超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)、白细胞介素-6(interleukin 6,IL-6)、肿瘤坏死因子α(Tumor necrosis factorα,TNF-α)、空腹血糖(fasting blood-glucose,FBG)、空腹胰岛素(fasting insulin,FINS)水平,比较PTX+AT前后各指标的变化。结果①PTX+AT后3个月,血CH、TG、LDL、P、iPTH水平较术前降低,差异有统计学意义(t值分别为-3.717,-2.261,-3.980,-3.541,-9.807;P值分别为0.013,0.039,0.011,0.019,<0.001);术后6个月,血CH、TG、LDL、P、iPTH水平较术前降低,差异有统计学意义(t值分别为-4.023,-2.097,-4.106,-4.004,-9.921;P值分别为0.009,0.040,0.010,0.011,<0.001),但术后6个月与术后3个月比较,差异无统计学意义(t值分别为-0.080,0.376,-0.004,-0.055,1.043;P值分别为0.058,0.072,0.064,0.059,0.088)。②PTX+AT后3个月,hs-CRP、IL-6、TNF-ɑ、胰岛素抵抗指数(insulin resistane,IR)较术前降低,差异有统计学意义(t值分别为-1.096,-1.849,-2.396,-2.887;P值分别为0.038,0.028,0.015,0.045);术后6个月,hs-CRP、IL-6、TNF-ɑ、IR水平与术前比较,差异有统计学意义(t值分别为-2.315,-2.421,-3.225,-3.000;P值分别为0.027,0.019,0.006,0.037),其中hsCRP、IL-6、TNF-ɑ较PTX+AT后3个月进一步降低,有统计学差异(t值分别为-2.011,-2.376,-3.333;P值分别为0.031,0.022,0.005),IR较术后3个月无再降低,无统计学差异(t=-0.006;P=0.679)。结论PTX+AT是慢性肾衰竭继发严重SHPT的有效治疗手段,能通过改善微炎症状态和胰岛素抵抗,纠正脂质代谢紊乱。

Objective To observe the effect of parathyroidectomy with forearm autograft(PTX+AT)on insulin resistance and microinflammatory status in uremic patients with secondary hyperparathyroidism.Methods A total of 38 uremic patients with secondary hyperparathyroidism but without diabetes undergoing PTX+AT in the period from March 2017 to June 2108 in Guangzhou Panyu Central Hospital were retrospectively analyzed.Their intact parathyroid hormone(iPTH),blood phosphate(P),blood cholesterol(CH),triglyceride(TG),low density lipoprotein(LDL),high-sensitivity C-reactive protein(hs-CRP),interleukin 6(IL-6)and tumor necrosis factor Q(TNF-Q),fasting blood glucose(FBG)and fasting blood insulin(FINS)were compare before and after PTX+AT.Results①After PTX+AT for 3 months,CH,TG,LDL,P and iPTH decreased significantly(t=-3.717,-2.261,-3.980,-3.541 and-9.807 respectively;P=0.013,0.039,0.011,0.019 and<0.001 respectively)as compared to those before PTX+AT.After PTX+AT for 6 months,CH,TG,LDL,P and iPTH decreased significantly(t=-4.023,-2.097,-4.106,-4.004 and-9.921 respectively;P=0.009,0.040,0.010,0.011 and<0.001 respectively)as compared to those before PTX+AT,but without statistical signifi-Conclusion PTX+AT is effective to treat severe secondary hyperparathyroidism in uremic patients,which can also improve microinflammation,IR and derangement of lipid metabolism.