PTX加自体移植术治疗血液透析SHPT的疗效分析
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摘要
目的探讨甲状旁腺全切除(PTX)加自体移植术治疗透析患者继发性甲状旁腺功能亢进症(SHPT)的疗效。方法回顾性分析100例行PTX加自体移植术治疗的血液透析SHPT患者的临床资料,比较术前以及术后1 w、3个月、6个月患者的临床症状、血钙、血磷、碱性磷酸酶(ALP)、i PTH水平及肾病相关生活质量评定表(KDTA)评分变化,统计术后6个月并发症及复发情况。结果术后患者骨关节疼痛、肌无力、皮肤瘙痒、失眠、异位钙化发生率均明显低于术前(P <0.05,表1),且随着术后时间延长逐渐降低;术后患者的血钙、血磷、i PTH水平明显降低(P <0.05),但呈现先下降后升高的趋势;而术后ALP的变化呈先升高后持续下降的趋势;术后患者的KDTA评分逐渐升高。随访6个月期间,有4例复发,但无一例发生肌肉注射种植的局部不良反应。结论 PTX加自体移植术是治疗血液透析SHPT安全有效的手段,可显著改善患者的临床症状、骨代谢水平及生活质量,且复发率较低。
Objective To explore the efficacy of parathyroidectomy(PTX) combined with autologous transplantation in the treatment of secondary hyperparathyroidism(SHPT) in hemodialysis patients. Methods The clinical data of 100 hemodialysis patients with SHPT treated by PTX plus autologous transplantation were retrospectively analyzed. The clinical symptoms, serum calcium,phosphorus, alkaline phosphatase(ALP), i PTH level and KDTA score were compared before and one week, three months and six months after the operation, and the complications and recurrence were counted six months after the operation. Results The incidence of bone and joint pain, muscle weakness, skin pruritus, insomnia and ectopic calcification was significantly lower than that before the operation(P < 0.05, Table 1), and gradually decreased with the prolongation of the operation time; the levels of serum calcium,phosphorus and i PTH in patients after the operation decreased significantly(P < 0.05), but decreased first and then increased, while the changes of ALP after the operation showed a trend of increasing first and then decreasing continuously. The KDTA score of patients increased gradually after the operation. During the follow-up period of six months, there was recurrence in four cases, but no l ocal adverse reactions of intramuscular implantation occurred. Conclusion PTX plus autologous transplantation is a kind of safe and effective treatment for SHPT in hemodialysis patients. It can significantly improve the clinical symptoms, bone metabolism and quality of life, with low recurrence rate.
Objective To explore the efficacy of parathyroidectomy(PTX) combined with autologous transplantation in the treatment of secondary hyperparathyroidism(SHPT) in hemodialysis patients. Methods The clinical data of 100 hemodialysis patients with SHPT treated by PTX plus autologous transplantation were retrospectively analyzed. The clinical symptoms, serum calcium,phosphorus, alkaline phosphatase(ALP), i PTH level and KDTA score were compared before and one week, three months and six months after the operation, and the complications and recurrence were counted six months after the operation. Results The incidence of bone and joint pain, muscle weakness, skin pruritus, insomnia and ectopic calcification was significantly lower than that before the operation(P < 0.05, Table 1), and gradually decreased with the prolongation of the operation time; the levels of serum calcium,phosphorus and i PTH in patients after the operation decreased significantly(P < 0.05), but decreased first and then increased, while the changes of ALP after the operation showed a trend of increasing first and then decreasing continuously. The KDTA score of patients increased gradually after the operation. During the follow-up period of six months, there was recurrence in four cases, but no l ocal adverse reactions of intramuscular implantation occurred. Conclusion PTX plus autologous transplantation is a kind of safe and effective treatment for SHPT in hemodialysis patients. It can significantly improve the clinical symptoms, bone metabolism and quality of life, with low recurrence rate.
引文
[1]陈彬.高通量血液透析在尿毒症合并继发性甲状旁腺功能亢进中的应用研究[J].中国全科医学,2015,18(12):1441-1445.
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[4]张海东,龚单春,刘亚群,等.甲状腺全切手术中甲状旁腺的保护[J].中华耳鼻咽喉头颈外科杂志,2014,49(11):889-892.
[5]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.
[6]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.
[7]李鸿,余卓锦,刘少清,等.继发性甲状旁腺功能亢进症患者甲状旁腺全切术后甲状旁腺功能的变化[J].广东医学,2017,38(5):736-738,741.
[2]刁宗礼,郭维康,刘莎,等.继发性甲状旁腺功能亢进的药物治疗进展[J].中国全科医学,2015,18(26):3245-3247.
[3]徐天华,刘芳婕,王力宁,等.甲状旁腺切除加自体前臂移植术治疗维持性血液透析继发性甲状旁腺功能亢进症疗效分析[J].中国实用内科杂志,2015,35(6):522-524.
[4]张海东,龚单春,刘亚群,等.甲状腺全切手术中甲状旁腺的保护[J].中华耳鼻咽喉头颈外科杂志,2014,49(11):889-892.
[5]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.
[6]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.
[7]李鸿,余卓锦,刘少清,等.继发性甲状旁腺功能亢进症患者甲状旁腺全切术后甲状旁腺功能的变化[J].广东医学,2017,38(5):736-738,741.