长期慢性肾衰患者继发性甲状旁腺功能亢进症诊治体会

Diagnosis and Treatment of Secondary Hy-perparathyroidism in Patients with Long-Term Chronic Renal Failure

继发性甲状旁腺功能亢进症(secondary hyperparathyroidism, SHPT)是慢性肾衰长期血液透析患者的常见并发症,对于通过低磷饮食、磷结合剂、补充钙剂和维生素D等内科保守治疗无效的难治性SHPT,甲状旁腺切除术日益受到重视,但其手术指征尚缺乏可靠的循证医学证据。本文结合我们对一例18年无尿的61岁SHPT患者的诊治体会,深入探讨SHPT的发生机制、临床表现、辅助检查、治疗原则,以期进一步提高其治疗效果。

Secondary hyperparathyroidism (SHPT) is a common complication in hemodialysis patients with chronic renal failure. For patients with refractory SHPT, who have no response to therapies such as low phosphorus diet, phosphorus binders, calcium supplements and vitamin D, parathyroidectomy has received increasing attention. However, evidence-based medicine shows that there is still con-troversy regarding surgical methods, efficacy and safety. Based on our experience in the diagnosis and treatment of a 61-year-old female with SHPT and chronic renal failure manifested as no urine for 18 years, we further explored the pathogenesis, clinical manifestations, supplementary exami-nation, and treatment of SHPT in order to further improve the treatment of this disorder.