营养状况对伴继发性甲状旁腺功能亢进的血液透析患者手术效果及相关指标的影响

The impact of nutritional status on surgical outcomes and related indicators in hemodialysis patients with secondary hyperparathyroidism

目的观察营养状况对伴继发性甲状旁腺功能亢进的维持性血液透析患者行甲状旁腺切除术的手术效果、营养指标及肾性贫血的影响。方法回顾性选取2016年1月至2021年1月在广州市花都区人民医院35例行维持性血液透析伴继发性甲状旁腺功能亢进患者,均因药物治疗无效后给予全甲状旁腺切除伴自体前臂移植术。术前根据患者营养状况评分将其分为无营养不良组(0~1分)、轻度养不良组(2~4分)、中重度营养不良组(5~12分),观察不同组别患者术前及术后不同时间点血清甲状旁腺素、血钙、血磷、血白蛋白等指标变化情况。结果不同营养状况的维持性血液透析患者接受甲状旁腺切除术后3、6、12个月血清甲状旁腺素、血磷及钙磷乘积均较术前明显下降,差异有统计学意义(均P<0.05)。无营养不良组患者术后3、6、12个月白蛋白、淋巴细胞计数及总胆固醇水平较术前无明显变化(均P>0.05);轻度营养不良组患者淋巴细胞计数在术后6、12个月较术前升高,差异有统计学意义(均P<0.05)。中重度营养不良组患者术后3、6、12个月白蛋白及总胆固醇水平均较术前升高,差异有统计学意义(均P<0.05)。无营养不良组及轻度营养不良组患者术后6、12个月Hb水平较术前升高,差异有统计学意义(均P<0.05);中重度营养不良组患者术后3、6、12个月Hb水平较术前升高,差异有统计学意义(均P<0.05)。结论营养状况影响血液透析患者行甲状旁腺切除术的长期效果,甲状旁腺切除术可明显改善伴有继发性甲状旁腺功能亢进的血液透析患者的营养状况及贫血状况,这种效果在术前即存在中重度营养不良的患者中更明显。

Objective To observe the effects of nutritional status on the surgical outcomes,nutritional indicators,and renal anemia of maintenance hemodialysis patients with secondary hyperparathyroidism undergoing parathyroidectomy.Methods A retrospective study was conducted on 35 patients who underwent maintenance hemodialysis with secondary hyperparathyroidism at Huadu District People's Hospital of Guangzhou from January 2016 to January 2021.All patients underwent total parathyroidectomy with autologous forearm transplantation due to ineffective drug treatment.Before surgery,patients were divided into three groups based on their nutritional status scores:no malnutrition group(O-1 points),mild malnutrition group(2-4 points),and moderate to severe malnutrition group(5-12 points).The changes in serum parathyroid hormone,blood calcium,blood phosphorus,blood albumin,and other indicators were observed at different time points before and after surgery in different groups of patients.Results The serum parathyroid hormone,blood phosphorus,and calcium phosphorus product of maintenance hemodialysis patients with different nutritional status who underwent parathyroidectomy at 3,6,and 12 months were significantly decreased compared with preoperative levels,and the differences were statistically significant(all P<0.05).There were no significant changes in albumin,lymphocyte count,and total cholesterol levels in patients without malnutrition at 3,6,and 12 months after surgery compared with preoperative levels(all P>0.05);The lymphocyte count of patients with mild malnutrition increased significantly at 6 and 12 months after surgery compared to preoperative levels(all P<0.05).The levels of albumin and total cholesterol in patients with moderate to severe malnutrition increased significantly at 3,6,and 12 months after surgery compared with preoperative levels(all P<0.05).The Hb levels of patients without malnutrition and those with mild malnutrition increased significantly at 6 and 12 months after surgery compared with preoperative levels(all P<0.05);The Hb levels of patients with moderate to severe malnutrition increased significantly at 3,6,and 12 months after surgery compared with preoperative levels(all P<0.05).Conclusions Nutritional status affects the long-term outcomes of parathyroidectomy in hemodialysis patients,and parathyroidectomy can significantly improve the nutritional and anemia status of hemodialysis patients with secondary hyperparathyroidism.This effect is more pronounced in patients with moderate to severe malnutrition before surgery.