甲状旁腺全切术后低甲状旁腺激素水平对患者冠脉钙化积分及心血管事件的影响
Effect of low level of iPTH after parathyroidectomy on cardiovascular events and coronary artery calcification score in CKD patients

朱峰.甲状旁腺全切术后低甲状旁腺激素水平对患者冠脉钙化积分及心血管事件的影响[J].内科急危重症杂志,2019,25(3):195-197

扫码阅读全文

DOI：10.11768/nkjwzzzz20190306

中文关键词: 继发性甲状旁腺功能亢进症甲状旁腺全切术冠状动脉钙化甲状旁腺激素

英文关键词:

基金项目:大连市卫生科研课题(No:1611095)

作者	单位	E-mail
朱峰	大连大学附属新华医院	23339399@163.com

摘要点击次数: 1809

全文下载次数: 2965

中文摘要:

目的:探讨慢性肾脏病5期合并甲状旁腺功能亢进症（简称甲旁亢）患者行甲状旁腺切除术后甲状旁腺激素（iPTH）的合理控制范围。方法： 60例维持性血液透析伴发甲旁亢行甲状旁腺切除术患者，分为iPTH<60 pg/mL， 60≤iPTH<150 pg/mL， 150≤iPTH≤300 pg/mL 3组，统计3组冠脉钙化积分情况。结果：手术治疗后患者Ca2+、P5+、钙磷乘积、iPTH、冠脉钙化积分均下降（均P<0.05），术后随着iPTH逐渐降低，冠脉钙化积分逐渐增加（P<0.05）；但 60≤iPTH<150 pg/mL组与150≤iPTH≤300 pg/mL比较，心血管各项相关事件无明显差异（P> 0.05)，提示iPTH 60~300 pg/mL时心血管事件发生率相当，随着iPTH进一步降低，iPTH 0~60 pg/mL组心血管各项相关事件明显升高（P<0.05）。结论：慢性肾脏病5期伴发甲旁亢行甲状旁腺切除术后，冠脉钙化明显缓解，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。

英文摘要:

Objective: To investigate the correlation between different levels of intact parathyroid hormone (iPTH) and coronary artery calcification (CAC) in consecutive dialysis patients with secondary hyperparathyroidism (SHPT) after parathyroidectomy, and discuss the reasonable control range of iPTH after operation. Method: Sixty consecutive dialysis patients with SHPT after parathyroidectomy were enrolled in this study. The patients were divided into three groups: iPTH <60pg/mL, 60≤iPTH<150pg/mL、150≤iPTH≤300pg/mL. The scores of CAC in the three groups were calculated. Result: The levels of iPTH, calcium, phosphorus, calcium and phosphorus product and CAC score were significantly lower than those before operation (P<0.05. After operation, with the gradual decrease in iPTH, the total score of CAC gradually increased, and the difference was statistically significant (P<0.05). However, there was no significant difference in cardiovascular events between 60≤iPTH<150pg/mL group and 150≤iPTH≤300pg/mL group (P>0.05). The incidence of cardiovascular events in iPTH0-60pg/mL group was significantly higher than that in the other two groups (P<0.05). Conclusion: Parathyroidectomy is associated with a significant decrease in vascular calcification in dialysis patients with SHPT, and it can reduce blood phosphorus level effectively. But the incidence and mortality of cardiovascular events in patients with low iPTH after operation are significantly higher.