慢性肾病继发甲状旁腺功能亢进的手术和药物治疗疗效分析

Efficacy analysis of medical and surgical treatments in chronic k idney disease patients with secondary hyperparathyroidism

目的比较手术和药物治疗继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)的疗效。方法回顾性分析同济医院2013年1月～2017年6月收治的137例SHPT患者的临床资料,比较不同治疗方式前后患者临床特征及复发情况。结果手术组53例患者,平均透析时长(78.0±4.9)个月;药物组84例,平均透析时长(62.0±6.4)个月。治疗后两组血清全段甲状旁腺激素(intact parathyroid hormone,i PTH)均有下降,但手术组下降幅度更显著,且远期效果满意[3年后为(67.4±7.4)pg/ml]。手术组血清钙下降较明显,药物组无明显下降。复发率手术组为7.5%,药物组为15.5%,且药物组5例(5.9%)患者出现持续性甲状旁腺功能亢进。结论手术是治疗SHPT的有效方法,即使对于病情更复杂的患者也能在不增加并发症风险的前提下获得满意疗效。

OBJECTIVE To investigate the effects of surgical and medical treatments on chronic kidney disease (CKD) patients with secondary hyperparathyroidism (SHPT). METHODS A total of 137 CKD patients with SHPT in Tongji Hospital from 2013 to 2017 were collected in this systematic retrospective study. We compared the improvement of clinical symptoms and recurrence rate before and after treatment. RESULTS Surgical group was comprised of 53 patients and received maintenance dialysis for average (78.0±4.9) months, while medical group was comprised of 84 patients and received maintenance dialysis for average (62.0±6.4) months. After treatment, the average in tact parathyroid hormone (iPTH) in both groups reduced significantly (surgical group: P<0.001, medical group: P=0.037). The serum iPTH in surgical group was decreased apparently compared with medical group (P=0.015) and maintained satisfied result during the 3 years of follow-up [(67.4±7.4) pg/ml]. The reduction of average serum corrected calcium was more significant in surgical group (P=0.001), while there was no obvious decrease in medical group (P=0.443). The recurrence rate in surgical group was 7.5% and in medical group was 15.5%(P=0.024). Beyond that, 5 (5.9%) patients suffered persistent hyperparathyroidism in medical group. CONCLUSION Surgical treatment is an effective way to control serum iPTH and calcium chronically for SHPT patients. In addition, complex SHPT patients can also receive satisfied outcome by surgical treatment, without increasing risk of complication.