尿毒症继发甲状旁腺功能亢进不同治疗方法的临床研究

Clinical outcomes of different treatment methods foRsecondary hyperparathyroidism in uremic patients

目的:比较甲状旁腺手术(PTX)和西那卡塞药物治疗尿毒症继发甲状旁腺功能亢进(SHPT)的疗效及安全性。方法:本研究选取2017年6月~2019年1月黄山市人民医院收治的尿毒症维持透析的SHPT(iPTH>800 pg/mL)且传统药物治疗无效的患者共21例,分两组,一组手术治疗,另一组药物治疗。分析两组患者治疗前后血钙、磷、血碱性磷酸酶(AKP)结果,甲状旁腺素(iPTH)及瘙痒、骨痛、乏力等症状的变化,同时比较两组间治疗复发率。结果:21例患者中,PTX组8例,行甲状旁腺全切+自体前臂移植术(tPTX+AT),手术成功率100%,半年内复发性SHPT和持续性SHPT患者共25%(各1例)。西那卡塞组13例,口服西那卡塞治疗,半年内持续性或复发性SHPT占46.15%(共6例)。两组治疗后皮肤瘙痒、骨痛及乏力均得到不同程度缓解,两组在性别构成、年龄、透析龄等方面的差异无统计学意义。两组均能降低血钙,但两组比较差异无统计学意义;两种治疗方式均能有效降低血磷、血AKP和iPTH(P<0.05)。PTX组均值更低,效果更明显。复发率手术组低于西那卡塞组,但差异无统计学意义(P>O.05)。结论:①PTX和西那卡塞均可以显著改善SHPT患者的症状;②与西那卡塞相比,PTX降低血磷、iPTH、AKP更明显;③PTX治疗SHPT效果优于西那卡塞。

Objective:To compare the efficacy and safety of parathyroidectomy(PTX)and cinacalcet in the treatment of secondary hyperparathyrothyroidism(SHPT)in uremic patients.Methods:Twenty-one uremic cases of SHPT(iPTH>800 pg/mL)with conventional medication failure,admitted to and treated in ouRhospital,were included from June 2017 to January 2019,and divided into surgical group and medication group.Then the two groups were compared concerning the changes of serum calcium,phosphorus,alkaline phosphatase(AKP)and parathyroxine(intact parathyroid hormone,iPTH)levels before and afteRtreatment,incidences of pruritus,bone pain,fatigue and otheRsymptoms as well as recurrence rate.Results:In the 21 patients,8 underwent total parathyroidectomy and autologous forearm transplantation(tPTX+AT),with successful rate of 100%.Recurrent SHPT(1 case)and persistent SHPT(1 case)within half a yeaRwere found in 25%of the patients following surgery,and persistent oRrecurrent SHPT was seen in 46.15%(6 cases)of the patients by medication.AfteRtreatment,skin pruritus,bone pain and fatigue were relieved in different degrees,yet there was no significant difference in genders,age and yeaRto receive dialysis between the two groups.Although blood calcium was reduced in both groups,yet difference was insignificant.The two methods led to effectively reduced serum phosphorus,AKP and iPTH levels(P<0.05),and the decrease was more obvious in patients treated by PTX.The recurrence rate was loweRin the surgical group than in the medication group,yet difference was insignificant(P>0.05).Conclusion:Both PTX and cinacalcet can significantly improve the symptoms of uremic patients with SHPT,and PTX can betteRimprove phosphorus,iPTH and AKP levels than medication,suggesting that PTX is superioRto cinacalcet in the treatment of uremic patients with SHPT.