不同透析方式患者行甲状旁腺切除的临床特点及术后复发情况分析

Clinical characteristics and postoperative recurrence of parathyroidectomy patients with different dialysis modalities

目的对比血液透析(hemodialysis,HD)与腹膜透析(peritoneal dialysis,PD)患者中行甲状旁腺切除术(parathyroidectomy,PTX)治疗的继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)患者的临床特点及术后复发情况。方法回顾性分析2014年4月至2019年5月在本院确诊SHPT并首次接受PTX治疗的患者。按术前透析方式将患者分为HD组(54例)和PD组(45例),并对两组患者术前临床资料及术后病理类型、生化指标、SHPT复发情况等进行比较。结果HD组患者透析龄、血压、血清碱性磷酸酶及全段甲状旁腺素(intact parathyroid hormone,iPTH)水平及二尖瓣钙化率较PD组高(P<0.05),术后病理类型分布相似(P>0.05)。术后相同时间点两组间血清iPTH、血钙、血磷水平差异无统计学意义(P>0.05)。Kaplan-Meier生存曲线分析显示两组间累积未复发率差异无统计学意义(P>0.05)。多因素Cox回归分析显示术后最低iPTH>3 ng/L是SHPT复发的独立危险因素(OR=2.260,P=0.019)。ROC曲线结果显示,术后1周iPTH>3.25 ng/L、术后1个月iPTH>18.45 ng/L及术后3个月iPTH>90.75 ng/L对术后SHPT复发具有预测价值。结论HD与PD患者PTX术后病理类型、iPTH及钙磷代谢、SHPT复发情况等方面均差异无统计学意义,术后最低iPTH>3 ng/L是PTX术后患者发生SHPT复发的独立危险因素,术后iPTH水平是SHPT复发的可靠预测指标。

Objective To compare the clinical characteristics and postoperative recurrence of parathyroidectomy(PTX)of hemodialysis(HD)versus peritoneal dialysis(PD)patients with secondary hyperparathyroidism(SHPT).Methods From April 2014 to May 2019,SHPT patients initially undergoing PTX were reviewed retrospectively.They were divided into two groups of HD(n=54)and PD(n=45)according to pre-PTX dialysis modality.Preoperative clinical data,pathological types,laboratory tests and recurrence of SHPT after PTX were compared.Results Compared with PD counterparts,HD patients had a longer dialysis duration and higher levels of blood pressure,serum alkaline phosphatase,serum intact parathyroid hormone(iPTH)and mitral valve calcification rate(P<0.05).The distribution of postoperative pathological types was similar between two groups(P>0.05).At the same timepoint after PTX,no significant inter-group differences existed in serum levels of iPTH,calcium or phosphorus(P>0.05).Kaplan-Meier survival curve analysis revealed no inter-group statistical difference in cumulative non-recurrence rate(P>0.05).Multivariate Cox regression analysis indicated that minimal postoperative iPTH>3 ng/L was an independent risk factor for SHPT recurrence(OR=2.260,P=0.019).Receiver operating characteristic(ROC)curve revealed that postoperative iPTH>3.25 ng/L after 1 week,iPTH>18.45 ng/L after 1 month and iPTH>90.75 ng/L after 3months could be utilized for predicting SHPT recurrence after PTX.Conclusion No significant difference of parathyroid pathological types,postoperative iPTH,calcium and phosphorus metabolism,and SHPT recurrence existed between HD and PD patients.Minimal postoperative iPTH>3 ng/L is an independent risk factor for SHPT recurrence in patients after PTX and postoperative iPTH level is a more reliable predictor of SHPT recurrence.