摘要
目的通过观察终末期肾病合并继发甲状旁腺功能亢进症患者行甲状旁腺切除术后不同全段甲状旁腺激素(intact parathormone,iPTH)水平与临床心血管事件相关性研究,探讨术后iPTH合理控制范围。方法 60例维持性血液透析伴继发甲状旁腺功能亢进行甲状旁腺切除术后患者,分为iPTH<60pg/ml,iPTH60～150 pg/ml,iPTH150～300pg/ml 3组,统计相关数据分析。结果手术治疗后患者Ca、P、钙磷乘积、iPTH、冠状动脉钙化积分较治疗前下降(P值分别为0.018,0.034,0.023,0.007,0.006),术后随着iPTH逐渐降低,冠状动脉钙化积分逐渐增加,有统计学意义(P值分别为0.014,0.026),i PTH:0～60pg/ml组患者发生心绞痛、心肌梗死、心律失常、心血管事件死亡均明显高于上述2组,具有统计学意义(P值分别为0.023,0.037,0.014,0.046)。结论慢性肾脏病5期继发甲状旁腺功能亢进症行甲状旁腺切除术后,冠状动脉钙化明显缓解,同时可有效改善患者高磷情况,但过低iPTH可导致术后患者心血管事件的发生率明显升高,增加死亡率。
Objective To investigate the relationship between different parathyroid hormone level and clinical cardiovascular events in the consecutive dialysis patients with secondary hyperparathyroidism after parathyroidectomy,and to explore the reasonable control range of postoperative iPTH level.Method Sixty patients undergoing maintenance hemodialysis with secondary hyperparathyroidism after parathyroidectomy were divided into three groups:iPTH<60 pg/ml,iPTH 60-150 pg/ml and iPTH 150-300 pg/ml.Statistical analysis of the relevant data.Result The level of Ca,P,Ca×P,iPTH,CCS of the patients after parathyroidectomy were lower than those before operation(P=0.018,P=0.034,P=0.023,P=0.007,P=0.006).Postoperatively,as the iPTH gradually decreases,the coronary calcification score gradually increases,the difference had statistical significance(P=0.014,P=0.026).but the cardiovascular events in group iPTH<60 pg/ml were significantly higher than the above two groups,the difference had statistical significance(P=0.023,P=0.037,P=0.014,P=0.046).Conclusion Coronary artery calcification and hyperphosphatemia can be significantly alleviated after parathyroidectomy in CKD5 patients with secondary hyperparathyroidism.However,too low iPTH can significantly increase the incidence of cardiovascular events and mortality in postoperative patients.
作者
朱峰
王琳
辛明徽
刘强强
ZHU Feng;WANG Lin;XIN Ming-hui;LIU Qiang-qiang(Department of Nephrology,Xinhua Hospital of Dalian University,Dalian116021,China)
出处
《中国血液净化》
CSCD
2019年第2期104-106,共3页
Chinese Journal of Blood Purification
基金
大连市卫生科研课题1611095
