终末期肾脏病伴继发性甲状旁腺功能亢进症患者生化指标的特征及血管钙化情况分析
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摘要
目的:探究终末期肾脏病伴继发性甲状旁腺功能亢进症患者生化指标的特征。方法:选取2015年6月-2016年6月在本院治疗的100例慢性肾病伴继发性甲状旁腺功能亢进症患者为研究组,100例健康人为对照组,其中研究组进行透析治疗。观察研究组不同年龄段患者的钙化情况,比较研究组治疗3、6、12个月的血钙、甲状旁腺素、血磷水平,比较两组实验室检查结果(血清尿素、总胆固醇、ALP、cFGF-23、iPTH)。结果:不同年龄段患者钙化率比较差异有统计学意义(P<0.05);研究组血清尿素、总胆固醇、ALP、cFGF-23及iPTH水平均高于对照组,比较差异均有统计学意义(P<0.05);研究组不同治疗时间的血钙、甲状旁腺素以及血磷水平比较,差异均有统计学意义(P<0.05),其中治疗3、6、12个月的血钙、甲状旁腺素、血磷水平均呈下降趋势。结论:晚期肾病伴继发性甲状旁腺功能亢进症患者的血清尿素、总胆固醇、ALP、cFGF-23以及iPTH的指标均较高,在临床上有极其重要的意义,且患者的年龄越大,钙化率越高。
Objective:To explore the biochemical characteristics and vascular calcification of patients with end-stage renal disease and secondary hyperparathyroidism.Method:A total of 100 patients with chronic nephropathy and secondary hyperparathyroidism treated in our hospital from June 2015 to June 2016 were selected as study group and 100 healthy persons as control group.The study group was treated with dialysis.The calcification of patients of different age groups in study group was compared.The levels of serum calcium,parathyroid hormone and phosphorus after 3,6 and 12 months of treatment in study group were compared.The results of laboratory tests(serum urea,total cholesterol,ALP,cFGF-23,iPTH)between two groups were compared.Result:The calcification of patients of different age groups in study group was compared,the difference was statistically significant(P<0.05).The levels of serum urea,total cholesterol,ALP,cFGF-23 and iPTH in study group were higher than those of control group(P<0.05).The levels of serum calcium,parathyroid hormone and blood phosphorus in study group at different treatment time were compared,the differences were statistically significant(P<0.05),and blood calcium,parathyroid hormone and blood phosphorus levels decreased 3,6 and 12 months after treatment.Conclusion:Serum levels of urea,total cholesterol,ALP,cFGE-23 and iPTH were higher in end-stage renal disease patients with secondary hyperparathyroidism than those of control group,has important clinical significance,and the older,the higher the rate of calcification.
Objective:To explore the biochemical characteristics and vascular calcification of patients with end-stage renal disease and secondary hyperparathyroidism.Method:A total of 100 patients with chronic nephropathy and secondary hyperparathyroidism treated in our hospital from June 2015 to June 2016 were selected as study group and 100 healthy persons as control group.The study group was treated with dialysis.The calcification of patients of different age groups in study group was compared.The levels of serum calcium,parathyroid hormone and phosphorus after 3,6 and 12 months of treatment in study group were compared.The results of laboratory tests(serum urea,total cholesterol,ALP,cFGF-23,iPTH)between two groups were compared.Result:The calcification of patients of different age groups in study group was compared,the difference was statistically significant(P<0.05).The levels of serum urea,total cholesterol,ALP,cFGF-23 and iPTH in study group were higher than those of control group(P<0.05).The levels of serum calcium,parathyroid hormone and blood phosphorus in study group at different treatment time were compared,the differences were statistically significant(P<0.05),and blood calcium,parathyroid hormone and blood phosphorus levels decreased 3,6 and 12 months after treatment.Conclusion:Serum levels of urea,total cholesterol,ALP,cFGE-23 and iPTH were higher in end-stage renal disease patients with secondary hyperparathyroidism than those of control group,has important clinical significance,and the older,the higher the rate of calcification.
引文
[1]Singh O N,Maraka S,Rodriguezgutierrez R,et al.Comparative efficacy of parathyroidectomy and active surveillance in patients with mild primary hyperparathyroidism:a systematic review and meta-analysis[J].Osteoporosis Int,2016,27(12):3395-3407.
[2]杨昱,沈世凯,张健.甲状旁腺全切除自体前臂移植术治疗肾功能不全继发性甲状旁腺功能亢进[J].中国普通外科杂志,2016,25(5):643-647.
[3]Dural C,Okoh A K,Seicean A,et al.A pilot study investigating the effect of parathyroidectomy on arterial stiffness and coronary artery calcification in patients with primary hyperparathyroidism[J].Surgery,2016,159(1):218-224.
[4]张蕊,张念荣,席秋萍,等.维持性血液透析合并难治性继发性甲状旁腺功能亢进患者腹主动脉钙化相关因素分析[J].肾脏病与透析肾移植杂志,2017,26(5):432-437.
[5]Yeh M W,Zhou H,Adams A L,et al.The Relationship of Parathyroidectomy and Bisphosphonates With Fracture Risk in Primary Hyperparathyroidism:An Observational Study[J].Ann Intern Med,2016,164(11):715-723.
[6]胡亚,廖泉,曹少博,等.原发性甲状旁腺功能亢进术后低钙血症相关因素分析[J].中国实用外科杂志,2016,36(1):119-121.
[7]江瑶,查小明,邢昌赢,等.496例继发性甲状旁腺功能亢进并甲状旁腺切除术患者的临床特点[J].中华肾脏病杂志,2016,32(8):592-597.
[8]Li J G,Xiao Z S,Hu X J,et al.Total parathyroidectomy with forearm auto-transplantation improves the quality of life and reduces the recurrence of secondary hyperparathyroidism in chronic kidney disease patients[J].Medicine,2017,96(49):e9050.
[9]杨光,王宁宁,葛益飞,等.尿毒症继发甲状旁腺功能亢进症患者甲状旁腺切除术后骨转换标志物的短期变化[J].中华肾脏病杂志,2017,33(10):750-756.
[10]潘渊明,陈莎莎,温小红,等.慢性肾功能不全患者行甲状旁腺切除术的麻醉管理[J].临床麻醉学杂志,2016,32(11):1133-1134.
[11]姜超云,李洋,王素霞,等.尿毒症继发性甲旁亢患者甲状旁腺全切联合自体移植术后早期发生低钙血症的危险因素[J].第三军医大学学报,2017,39(5):472-476.
[12]Schneider R,Steinmetz C,Karakas E,et al.Influence of Parathyroidectomy on Bone Metabolism and Bone Pain in Patients with Secondary Hyperparathyroidism[J].Eur Surg Res,2018,59(1-2):35-47.
[13]薄少军,徐先发,邱传亚,等.甲状旁腺切除加部分自体移植术后持续继发性甲状旁腺功能亢进症的外科治疗[J].临床耳鼻咽喉头颈外科杂志,2018,21(2):142-147.
[14]胡亚,花苏榕,王梦一,等.可避免的原发性甲状旁腺功能亢进症再次手术临床分析[J].中华外科杂志,2017,55(8):582-586.
[15]张丽娜,江瑶,程晨,等.甲状旁腺切除术对慢性肾脏病5期患者血浆成纤维细胞生长因子23及心率变异性的影响[J].肾脏病与透析肾移植杂志,2016,25(1):40-45.
[16]陈慧敏,邢昌赢,张丽娜,等.慢性肾脏病5期患者血浆iPTH、(1-84)PTH、(7-84)PTH水平的特点及甲状旁腺切除术的影响[J].中华肾脏病杂志,2017,33(1):15-21.
[17]曾鸣,柳卫,王宁宁,等.99mTc-MIBI SPECT-CT技术在甲状旁腺切除术前定位诊断中的增益价值[J].中华肾脏病杂志,2017,33(2):86-91.
[18]余文洪,孙岩,卓燕.尿毒症患者继发甲状旁腺功能亢进合并甲状腺癌的临床特点及诊治[J].重庆医学,2017,46(25):3589-3590.
[19]何敬东,田中,李萃萃,等.低钙透析联合磷结合剂对血液透析患者钙磷代谢紊乱和冠状动脉钙化的影响[J].中国老年学,2017,37(16):4067-4069.
[20]左江乐,卢文,张敬杰,等.甲状旁腺切除加自体移植术对尿毒症患者近期临床症状及钙磷代谢的影响(附20例临床分析)[J].中国骨质疏松杂志,2016,22(10):1288-1292.
[2]杨昱,沈世凯,张健.甲状旁腺全切除自体前臂移植术治疗肾功能不全继发性甲状旁腺功能亢进[J].中国普通外科杂志,2016,25(5):643-647.
[3]Dural C,Okoh A K,Seicean A,et al.A pilot study investigating the effect of parathyroidectomy on arterial stiffness and coronary artery calcification in patients with primary hyperparathyroidism[J].Surgery,2016,159(1):218-224.
[4]张蕊,张念荣,席秋萍,等.维持性血液透析合并难治性继发性甲状旁腺功能亢进患者腹主动脉钙化相关因素分析[J].肾脏病与透析肾移植杂志,2017,26(5):432-437.
[5]Yeh M W,Zhou H,Adams A L,et al.The Relationship of Parathyroidectomy and Bisphosphonates With Fracture Risk in Primary Hyperparathyroidism:An Observational Study[J].Ann Intern Med,2016,164(11):715-723.
[6]胡亚,廖泉,曹少博,等.原发性甲状旁腺功能亢进术后低钙血症相关因素分析[J].中国实用外科杂志,2016,36(1):119-121.
[7]江瑶,查小明,邢昌赢,等.496例继发性甲状旁腺功能亢进并甲状旁腺切除术患者的临床特点[J].中华肾脏病杂志,2016,32(8):592-597.
[8]Li J G,Xiao Z S,Hu X J,et al.Total parathyroidectomy with forearm auto-transplantation improves the quality of life and reduces the recurrence of secondary hyperparathyroidism in chronic kidney disease patients[J].Medicine,2017,96(49):e9050.
[9]杨光,王宁宁,葛益飞,等.尿毒症继发甲状旁腺功能亢进症患者甲状旁腺切除术后骨转换标志物的短期变化[J].中华肾脏病杂志,2017,33(10):750-756.
[10]潘渊明,陈莎莎,温小红,等.慢性肾功能不全患者行甲状旁腺切除术的麻醉管理[J].临床麻醉学杂志,2016,32(11):1133-1134.
[11]姜超云,李洋,王素霞,等.尿毒症继发性甲旁亢患者甲状旁腺全切联合自体移植术后早期发生低钙血症的危险因素[J].第三军医大学学报,2017,39(5):472-476.
[12]Schneider R,Steinmetz C,Karakas E,et al.Influence of Parathyroidectomy on Bone Metabolism and Bone Pain in Patients with Secondary Hyperparathyroidism[J].Eur Surg Res,2018,59(1-2):35-47.
[13]薄少军,徐先发,邱传亚,等.甲状旁腺切除加部分自体移植术后持续继发性甲状旁腺功能亢进症的外科治疗[J].临床耳鼻咽喉头颈外科杂志,2018,21(2):142-147.
[14]胡亚,花苏榕,王梦一,等.可避免的原发性甲状旁腺功能亢进症再次手术临床分析[J].中华外科杂志,2017,55(8):582-586.
[15]张丽娜,江瑶,程晨,等.甲状旁腺切除术对慢性肾脏病5期患者血浆成纤维细胞生长因子23及心率变异性的影响[J].肾脏病与透析肾移植杂志,2016,25(1):40-45.
[16]陈慧敏,邢昌赢,张丽娜,等.慢性肾脏病5期患者血浆iPTH、(1-84)PTH、(7-84)PTH水平的特点及甲状旁腺切除术的影响[J].中华肾脏病杂志,2017,33(1):15-21.
[17]曾鸣,柳卫,王宁宁,等.99mTc-MIBI SPECT-CT技术在甲状旁腺切除术前定位诊断中的增益价值[J].中华肾脏病杂志,2017,33(2):86-91.
[18]余文洪,孙岩,卓燕.尿毒症患者继发甲状旁腺功能亢进合并甲状腺癌的临床特点及诊治[J].重庆医学,2017,46(25):3589-3590.
[19]何敬东,田中,李萃萃,等.低钙透析联合磷结合剂对血液透析患者钙磷代谢紊乱和冠状动脉钙化的影响[J].中国老年学,2017,37(16):4067-4069.
[20]左江乐,卢文,张敬杰,等.甲状旁腺切除加自体移植术对尿毒症患者近期临床症状及钙磷代谢的影响(附20例临床分析)[J].中国骨质疏松杂志,2016,22(10):1288-1292.