摘要
【目的】观察甲状旁腺切除联合前臂自体移植术(tPTX+AT)治疗维持性血液透析(MHD)伴继发性甲状旁腺功能亢进(SPTH)患者的疗效及其对可溶性Klotho蛋白、成纤维细胞生长因子23(FGF23)水平的影响。【方法】观察接受tPTX+AT治疗的90例MHD合并SPTH患者并发症发生情况以及治疗前、治疗后1、3、6、12个月生化指标、Klotho、FGF23水平变化。【结果】患者均顺利完成手术,发生术后出血3例,感染2例,低钙血症4例;喉反神经损伤,心律失常,高钾各1例;均于积极处理后好转。手术后1、3、6、12个月患者血钙、血磷、钙磷乘积、持续性全段甲状旁腺素(iPTH)、碱性磷酸酶(ALP)均较手术前降低(P<0.05)。手术后3、6、12个月患者、血红蛋白(Hb)、血清铁蛋白(SF)、红细胞压积(Hct)较手术治疗前升高,重组人促红细胞生成素(rHuEPO)用量、C反应蛋白(CRP)较手术治疗前降低(P<0.05)。手术前后尿素清除指数(Kt/V)比较差异无显著性(P>0.05)。手术后1、3、6、12个月患者FGF-23均较手术前降低,Klotho较手术前升高(P<0.05)。【结论】tPTX+AT治疗MHD伴SPTH患者并发症少,安全性高,可改善钙磷代谢,纠正营养及炎症状态,且可降低FGF-23、升高Klotho水平,效果显著。
【Objectivc】To evaluate the efficacy of parathyroidectomy combined with anterior wall autotransplantation(tPTXH-AT)in the treatment of maintenance hemodialysis(MHD)patients with severe secondary hyperparathyroidism(SPTH)»and investigate the effect on soluble Klotho protein and fibroblast growth factor 23(FGF23)levels.[Methods]Ninety patients complicated with MHD and SPTH,who underwent tPTX+AT treatment,were enrolled in the study.The incidence of complicatiorivS,biochemical parameters,Klotho and FGF23 levels before and 1,3,6 and 12 months after treatment were recorded.[Results]All patients underwent successful operation.There were 3 cases of postoperative hem orrhage 2 cases with postoperative infection,I case with laryngeal nerve injury,I case with arrhythmia.4 cases with hypocalcemia»and I case with high potassium.All of them got improved after active treatment.The levels of serum calcium,blood phosphorus,calcium and phosphorus product,iPTH and ALP at 1,3,6 and 12 months after surgery were lower than those before treatment(P<0.05).At 3,6,and 12 months after surgery,HI),Hct,and SF were higher than those before surgery(P<0.05).While the dose of rHuEPO and CRP were lower than those before surgery(P<0.05).There was no significant difference in Kt/V(urea clearance index)before and after surgery(P〉0.05).FGF-23 in patients at 1.3.6 and 12 months after surgery was lower than that before surgery,and Klotho was higher than that before surgery(P<0.05).【Conclusion】tPTX+AT has less complication in MHI)with SPTH patients and high safety.It can improve calcium metabolism,correct nutrition and inflammation status,and can reduce FC/F-23 and increase Klotho level.
作者
童昌军
刘勇
周加军
高峰
TONG Chang-jun;LIU Yong;ZHOU Jiajun(Yijishan Hospital of Wanna Medical College,WUhu Anhui,241001)
出处
《医学临床研究》
CAS
2020年第10期1494-1496,1499,共4页
Journal of Clinical Research
