甲状旁腺切除联合自体移植对尿毒症继发性 甲状旁腺功能亢进患者左心室肥厚 及血清Fetuin-A 的影响

Effect of total parathyroidectomy with auto-transplantation on left ventricular hypertroply and Fetuin-A of SHPT uremiu patients

摘要:

目的 研究甲状旁腺切除联合自体移植（tPTX+AT）对继发性甲状旁腺功能亢进（SHPT）尿毒 症患者的疗效及对左心室肥厚、血清胎球蛋白A（Fetuin-A）、炎症因子的影响。方法 74 例SHPT 尿毒症患者 被随机分为两组，每组37 例。对照组行常规治疗，观察组在此基础上行tPTX+AT 术。术后6 个月比较两组 患者甲状旁腺激素（iPTH）、血清钙、磷浓度变化，采用超声心动图检测左心室肥厚的指标变化情况，检测治 疗前后血清Fetuin-A、超敏C- 反应蛋白（hs-CRP）水平及白细胞介素6（IL-6）水平。结果 术后6 个月随 访，观察组的血清钙、血清磷、钙磷乘积以及iPTH 均下降（P <0.05），对照组上述指标变化差异无统计学意义 （P >0.05）。观察组舒张末期室间隔厚度（IVST）、左心室重量指数（LVMI）、左心室后壁厚度（LVPWT）均下降， 左心室射血分数（LVEF）升高（P <0.05）；钙化率变化差异无统计学意义（P >0.05）。对照组的IVST、LVMI、 LVPWT 变化差异无统计学意义（P >0.05）；但钙化率升高（P <0.05）。观察组Fetuin-A 升高，hs-CRP 和IL-6 水平下降（P <0.05）；对照组变化差异无统计学意义（P >0.05）。结论 tPTX+AT 术能有效降低SHPT 尿毒症患 者的血磷、血钙和iPTH 浓度，改善临床症状及患者的左心室肥厚，延缓心脏瓣膜钙化进展，同时上调Fetuin-A 浓度，下调IL-6 和hs-CRP 浓度。

Abstract:

Objective To analyze the effect of total parathyroidectomy with autologous transplantation (tPTX + AT) in the treatment of secondary hyperparathyroidism (SHPT) uremia patients and influence on left ventricular hypertrophy and Fetuin-A. Methods Totally 74 SHPT uremia patients were involved in this study, and were randomly divided into control group and observation group (n = 37). All patients were treated with standard therapy while patients in observation group received additional treatment of tPTX+AT. iPTH, serum concentration of calcium and phosphorus, Fetuin-A, IL-6 and hs-CRP were measured. Left ventricle was evaluated by echocardiographic test. Results Levels of iPTH, serum calcium and phosphorus, calcium-phosphorus product, hs-CRP and IL-6 in observation group were decreased and levels of fetuin-A were increased significantly (P < 0.05), while those in control group did not show any obvious change (P > 0.05). The IVST, LVMI and LVPWT in patients of observation group decreased while LVEF was increased dramatically (P < 0.05). However, no alteration in IVST, LVMI, and LVPWT in control group was witnessed (P < 0.05). Calcification rate did not show any change in observation group while that was increased obviously in control group. Conclusions tPTX + AT can improve the clinical symptoms, and delay the progression of cardiac valve calcification in patients with SHPT uremia.