维持性血液透析患者甲状旁腺全切术后营养不良和炎症状态的评价

Evaluation of malnutrition and inflammation after total parathyroidectomy in maintenance hemodialysis patients

目的评价维持性血液透析(maintenance hemodialysis,MHD)患者甲状旁腺切除术后营养不良炎症状态。方法选择MHD患者甲状旁腺切除患者23例,观察术后12月干体质量、血钙、血磷、全段甲状旁腺激素(intact parathyroid hormone,iPTH)、血红蛋白、红细胞比容、血清白蛋白、总铁结合力、以及营养不良-炎症评分(malnutrtion-inflammation score,MIS)的变化;并观察血清C反应蛋白(Creactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子(tumor necrosis factor,TNF-a)水平变化。结果与手术前比较,术后12月干体质量增加[(52.2±5.4)比(57.5±6.6)kg,t=-2.964,P=0.005];血红蛋白明显增加[(89.5±8.3)比(102.5±7.1)g/L,t=-5.716,P<0.001];红细胞比容明显增加[(31.1±3.1)比(38.7±4.1)%,t=-6.975,P<0.001];血清白蛋白明显增加[(31.2±4.2)比(40.2±4.7)g/L,t=-6.865,P<0.001];钙、磷和iPTH水平明显下降[(2.85±0.17)比(2.10±0.42)mmol/L,t=7.871,P<0.001;(1.99±0.26)比(1.13±0.17)mmol/L,t=13.432,P<0.001;(1536.0±252.0)比(144.4±41.9)ng/L,t=26.136,P<0.001];术后12月CRP、IL-6和TNF-α水平均明显下降[(10.2±1.8)比(4.1±1.2)ng/dl,t=13.583,P<0.001;(65.8±16.7)比(42.6±13.9)pg/ml,t=5.125,P<0.001;(49.6±13.7)比(34.6±8.5)pg/ml,t=4.468,P<0.001];MIS评分程度降低[(11.80±2.43)比(6.35±2.50)分,t=7.480,P<0.001]。结论甲状旁腺全切手术能有效改善维持性透析患者的营养不良和炎症状态,营养不良和炎症状态改善可能是继发性甲状旁腺功能亢进患者生存质量改善的机制之一。

Objective Evaluation of malnutrition and inflammation after parathyroidectomy in 23 patients with maintenance hemodialysis(MHD).Methods 23 MHD patients with parathyroidectomy were enrolled.Then,we observed the changes of dry weight,serum calcium,phosphate,intact parathyroid hormone(iPTH),hemoglobin,hematocrit,serum albumin,total iron binding capacity,and Malnutrtion-inflammation score(MIS)was calculated at 12 months after parathyroidectomy.Results Compared with condition before parathyroidectomy,patients’dry weight,hemoglobin,hematocrit and serum albumin increased significantly at 12 months after parathyroidectomy[(52.2±5.41)kg vs.(57.5±6.6)kg,t=-2.964,P=0.005;(89.5±8.3)g/L vs.(102.5±7.1)g/L,t=-5.716,P=0.000;(31.1±3.1)%vs.(38.7±4.1)%,t=-6.975,P<0.001;(31.2±4.2)g/L vs.(40.2±4.7)g/L,t=-6.865,P=0.000].The levels of calcium,phosphate and iPTH decreased significantly[(2.85±0.17)vs.(2.10±0.42)mmol/L,t=7.871,P<0.001;(1.99±0.26)vs.(1.13±0.17)mmol/L,t=13.432,P<0.001;(1536.0±252.0)vs.(144.4±41.9)ng/L,t=26.136,P<0.001].Meanwhile,the level of C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and MIS decreased significantly at 12 months after parathyroidectomy[(10.2±1.8)ng/dl vs.(4.1±1.2)ng/dl,t=13.583,P<0.001;(65.8±16.7)pg/ml vs.(42.6±13.9)pg/ml,t=5.125,P<0.001;(49.6±13.7)pg/ml,vs.(34.6±8.517)pg/ml,P<0.001;(11.80±2.43)scores vs.(6.35±2.50)scores,t=7.480,P<0.001).Conclusion Total parathyroidectomy can effectively improve the status of malnutrition and inflammation in MHD patients.Further,these will be beneficial to improve the quality of life in MHD patients with secondary hyperparathyroidism.