维持性血液透析的CKD合并SHPT患者甲状旁腺次全切除术后骨密度变化

Changes of bone mineral density after subtotal parathyroidectomy in patients with secondary hyperparathyroidism after maintenance hemodialysis for chronic kidney disease

目的评估合并继发甲状旁腺功能亢进(SHPT)的慢性肾脏病(CKD)维持性血液透析患者甲状旁腺次全切除术后骨密度变化。方法收集CKD血液透析后因合并SHPT接受甲状旁腺次全切除术的33例患者(手术组)和37例单纯药物治疗的同类患者(药物组)的临床资料。所有患者治疗前后均接受胸部CT扫描,以胸骨为测量位置,观察CT测量的骨钙积分变化,比较2组血钙、血磷、甲状旁腺激素以及骨密度等数据,分析手术与否和骨密度变化的关系。结果手术组治疗前后血钙、血磷、甲状旁腺激素以及骨密度差异有统计学意义(P均<0.05),骨密度升高;药物组治疗前后血钙、血磷、甲状旁腺激素以及骨密度差异无统计学意义(P均>0.05)。控制了年龄因素后,手术与否和骨密度变化存在相关性(P<0.05)。结论对血液透析后出现SHPT的CKD患者实施甲状旁腺次全切除术有助于改善其骨密度。

Objective To evaluate the changes of bone mineral density after subtotal parathyroidectomy in patients with secondary hyperparathyroidism after maintenance hemodialysis for chronic kidney disease.Methods Clinical data of 33 patients with chronic kidney disease undergoing subtotal parathyroidectomy after secondary hyperparathyroidism following hemodialysis(operation group)and 37 patients with the same diseases receiving drug therapy alone(drug group)were collected.All patients received chest CT scan before and after corresponding treatment.The changes of bone calcium score of the sternum were measured by CT scan serum calcium,serum phosphorus,parathyroid hormone and bone mineral density were statistically compared between two groups.The relationship between operation and changes of bone mineral density was analyzed.Results In the operation group,serum calcium,serum phosphorus,parathyroid hormone and bone mineral density had statistical significance before and after treatment(all P<0.05),and bone mineral density was increased.The serum calcium,serum phosphorus,parathyroid hormone and bone mineral density did not significantly differ before and after treatment in the drug group(all P>0.05).After the adjustment of age,operation was significantly correlated with the changes of bone mineral density(P<0.05).Conclusion Subtotal parathyroidectomy contributes to improving bone mineral density in patients with chronic kidney disease and secondary hyperparathyroidism after hemodialysis.