甲状旁腺全切术对继发性甲旁亢患者临床症状、抑郁焦虑情绪和生活质量的影响

Effects of total parathyroidectomy on clinical symptoms, depression and anxiety and quality of life in patients with secondary hyperparathyroidism

目的探讨甲状旁腺全切术对继发性甲状旁腺功能亢进症(SHPT)患者临床症状、抑郁焦虑情绪和生活质量的影响。方法选取2016年6月—2018年12月北部战区总医院肝胆外科收治的160例行甲状旁腺全切术治疗的慢性肾脏病继发SHPT患者。术前、术后6个月检测患者血清钙、磷、碱性磷酸酶(ALP)、全段甲状旁腺素(iPTH)水平。对所有患者进行Pasieka甲状旁腺症状评分(PAS);用汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)评价患者不良情绪;健康调查简表(SF-36)评价患者生活质量。结果与术前比较,术后6个月患者血钙、血磷、ALP、iPTH均明显降低(P<0.05)。患者PAS中13个症状条目评分和总分明显下降(P<0.05)。术后HAMD和HAMA评分均明显降低(P<0.05);SF-36生理健康评分和心理健康评分均明显升高(P<0.05)。PAS总分减分值与HAMD和HAMA减分值呈正相关(r=0.501、0.358,均P<0.05),与SF-36生理健康评分、心理健康评分减分值呈负相关(r=-0.567、-0.428,均P<0.05)。HAMD、HAMA减分值均与SF-36生理健康评分、心理健康评分减分值呈负相关(r=-0.368、-0.317、-0.433、-0.394,均P<0.05)。结论甲状旁腺全切术可以缓解SHTP患者的临床症状,改善抑郁焦虑情绪,提高生活质量。

Objective To explore the effect of total parathyroidectomy on clinical symptoms,depression and anxiety and quality of life in patients with secondary hyperparathyroidism(SHPT).Methods A total of 160 patients with SHPT secondary to chronic kidney disease who underwent total parathyroid resection admitted to the Department of Hepatobiliary Surgery of the General Hospital of Northern Theater Command from June 2016 to December 2018 were selected.Serum levels of calcium,phosphorus,alkaline phosphatase(ALP)and parathyroid hormone(iPTH)were measured before and Six months after operation.Pasieka parathyroid symptom score(PAS)was performed in all patients.Hamilton depression scale(HAMD)and hamilton anxiety scale(HAMA)were used to evaluate patients′negative emotions.Summary of health survey(SF-36)was used to evaluation of patient quality of life.Results Compared with preoperative,the blood calcium,blood phosphorus,ALP,and iPTH of the patients were significantly reduced at six months after operation(P<0.05).The scores and total scores of 13 symptom items in PAS decreased significantly(P<0.05).Postoperative HAMD and HAMA scores were significantly decreased(P<0.05).SF-36 physical health score and mental health score were significantly increased(P<0.05).PAS total score minus points were positively correlated with HAMD and HAMA scores(r=0.501,0.358,all P<0.05),and negatively correlated with SF-36 physiological health scores and mental health scores(r=-0.567,-0.428,all P<0.05).All HAMD and HAMA minus points were negatively correlated with SF-36 physiological health score and mental health score(r=-0.368,-0.317,-0.433,-0.394,all P<0.05).Conclusion Parathyroidectomy can alleviate the clinical symptoms,improve the depression and anxiety,and improve the quality of life of SHTP patients.