【摘要】 目的观察甲状旁腺切除术(parathyroidectomy, PTX)对尿毒症继发甲状旁腺功能亢进症(secondary hyperparathyroidism, SHPT)的维持性血液透析(maintenance hemodialysis, MHD)患者肾性贫血及促红细胞生成素(erythropoietin,EPO)用量的影响。方法回顾性分析2014年1月至2018年2月在福建医科大学附属龙岩第一医院因尿毒症SHPT接受PTX治疗的58例MHD患者,观察手术前及术后第3、6个月时血清钙、血清磷、碱性磷酸酶(AKP)、血清全段甲状旁腺激素(intact parathyroid hormone, iPTH)、血红蛋白(Hb)、红细胞比积(Hct)、促红细胞生成素(EPO)用量、血清铁蛋白(SF)、转铁蛋白饱和度(TS)、C反应蛋白(CRP)、血白蛋白(Alb)和尿素清除指数(Kt/V),分析术后3个月和6个月Hb水平及EPO用量的变化。结果 58例患者行PTX后iPTH水平明显下降(术前1828.88±811.2 ng/L,术后3个月56.75±158.4 ng/L,术后6个月64.52±178.5 ng/L;与术前比较P<0.05);与术前相比,术后3个月、6个月的血钙、血磷和ALP均明显下降(P<0.05)。术后Hb水平明显上升(术前99.92±14.26 g/L,术后6个月123.2±13.65 g/L,均P<0.05);术后EPO用量减少[术前235.18±62.65 U/(kg·周),术后3个月158.78±34.24 U/(kg·周),术后6个月112.53±25.37 U/(kg·周),均P<0.05]。结论甲状旁切除术能有效控制继发性甲状旁腺功能亢进,改善肾性贫血、减少促红细胞生成素用量。更多还原

【Abstract】 Objective To investigate the effect of parathyroidectomy(PTX)on the progression of renal anemia and erythropoietin dose in maintenance hemodialysis(MHD)patients with secondary hyperparathyroidism(SHPT)of uremia. Methods A total of 58 MHD patients with SHPT treated with PTX were retrospectively analyzed. The changes of serum intact parathyroid hormone(iPTH), calcium(Ca), phosphorus(P), alkaline phosphatsae(AKP), hemoglobulin(Hb), hematocrit(Hct), serum ferritin(SF), transferrin saturation(TS), c-reactive protein(CRP), albumin(Alb)and Kt/V at 3 months and6 months after PTX treatment were evaluated. The Hb level at 3 and 6 months after surgery and the doses of recombinant human erythropoietin(EPO)were recorded. Results Serum iPTH decreased dramatically(before PTX 1828.88±811.2 ng/L,three months after PTX 56.75±158.4 ng/L,six months after PTX 64.52±178.5 ng/L, P<0.05); Ca, P and AKP levels also decreased significantly after PTX(P<0.05). Hb increased after PTX(before PTX 99.92±14.26 g/L, six months after PTX123.2±13.65 g/L, P<0.05); meanwhile, the dose of EPO decreased after the operation[before PTX 235.18±62.65 U/(kg·W), three months after PTX 158.78±34.24 U/(kg·W),six months after PTX 112.53±25.37 U/(kg·W), P<0.05]. Conclusion PTX can effectively control secondary hyperparathyroidism, significantly improve the renal anemia, and decrease dose of erythropoietin in MHD patients with SHPT.更多还原