【摘要】 目的回顾总结再次手术、传统药物治疗与新型维生素D类似物及磷结合剂3种方案对甲状旁腺全切+前臂移植(total PTX+forearm autotransplantation,t PTX+AT)术后复发性及持续性甲状旁腺功能亢进的治疗效果。方法调查郑州大学第一附属医院2013年5月至2014年5月16例尿毒症患者行t PTX+AT术后出现复发性(13例)及持续性(3例)甲状旁腺功能亢进的治疗情况,治疗方案包括再次手术切除颈部残留的甲状旁腺或前臂移植物5例(方案i)、传统内科药物治疗6例(方案ii)、新型维生素D类似物及磷结合剂治疗5例(方案iii),对三种治疗方案进行评价。结果 3组患者在治疗后i PTH均有明显下降(P<0.05),ii组下降速度与幅度低于iii组患者(P<0.05),i组2名前臂移植物复发的患者因"前臂甲状旁腺移植物切除"失败在术后i PTH无明显变化;i组患者手术后血钙较手术前明显下降(P<0.05),手术后2周血磷水平下降明显(P<0.05),后逐渐上升,至34周血磷与手术前比较无明显变化(P>0.05),ii组患者治疗前后血钙、血磷上升明显(P<0.05),iii组患者治疗后血钙轻度升高,但是仍处于正常范围内,与治疗前相比较差异无统计学意义(P>0.05);血磷较治疗前明显下降(P<0.05);iii组患者在生理功能、躯体疼痛、情感职能、精神健康4个维度分值明显高于i组和ii组患者(均P<0.05)。结论方案iii在降低i PTH水平、减少高钙血症与高磷血症风险、改善患者生活质量等方面可能优于方案i与ii。更多还原

【Abstract】 Objective To review the efficacy of re-operation, traditional medication therapy, and new vitamin D(VD) analogue combined with phosphate binder on the recurrent and persistent hyperparathyroidism after total parathyroidectomy and forearm autotransplantation(t PTX + AT). Methods The uremic patients with recurrent(13 cases) and persistent(3 cases) hyperparathyroidism after t PTX+AT from May 2013 to May 2014 in our hospital were analyzed. The treatment of these patients included re-operation to excise residual parathyroid gland in neck or forearm autotransplanted gland(group A, 5 cases), traditional medication therapy(group B, 6 cases), and new VD analogue combined with phosphate binder(group C, 5 cases). The effects of the three therapies were compared. Results Serum i PTH decreased significantly in all of the three groups after the treatment(P<0.05) with the decrease rate and amplitude greater in group C than in group B(P<0.05); i PTH was unchanged in the 2 cases in group A because of the failure of re-operation. In group A,serum calcium decreased significantly after re-operation(P<0.05), serum phosphate decreased after re-operation for 2 weeks(P<0.05) then gradually increased to the level before the re- operation after 34 weeks(P >0.05). In group B, serum calcium and phosphate increased significantly after routine medication therapy(P<0.05). In group C after new VD analogue + phosphate binder therapy, serum calcium increased slightly but was still in the normal range, and changed insignificantly as compared to the level before the therapy(P<0.05); serum phosphate decreased(P<0.05); the four- dimension scores of physiological functions, physical pain, emotional function, and mental health were significantly higher than those in groups A and B(P<0.05).Conclusion The therapy for group C(new VD analogue + phosphate binder) was better than the therapies for group A(re-operation) and B(routine medication) in lowering i PTH, reducing the risks for hypercalcemia and hyperphosphatemia, and improving quality of life in patients with recurrent and persistent hyperparathyroidism after t PTX+AT.更多还原