王立源?刘双信?崔燕海?曾睿?黄金龙?植奇升

【摘要】目的 評估合并继发甲状旁腺功能亢进（SHPT）的慢性肾脏病（CKD）维持性血液透析患者甲状旁腺次全切除术后骨密度变化。方法 收集CKD血液透析后因合并SHPT接受甲状旁腺次全切除术的33例患者（手术组）和37例单纯药物治疗的同类患者（药物组）的临床资料。所有患者治疗前后均接受胸部CT扫描，以胸骨为测量位置，观察CT测量的骨钙积分变化，比较2组血钙、血磷、甲状旁腺激素以及骨密度等数据，分析手术与否和骨密度变化的关系。结果 手术组治疗前后血钙、血磷、甲状旁腺激素以及骨密度差异有统计学意义（P均< 0.05），骨密度升高;药物组治疗前后血钙、血磷、甲状旁腺激素以及骨密度差异无统计学意义（P均> 0.05）。控制了年龄因素后，手术与否和骨密度变化存在相关性（P < 0.05）。结论 对血液透析后出现SHPT的CKD患者实施甲状旁腺次全切除术有助于改善其骨密度。

【关键词】慢性肾脏病;骨密度;甲状旁腺亢进;计算机体层成像

Changes of bone mineral density after subtotal parathyroidectomy in patients with secondary hyperparathyroidism after maintenance hemodialysis for chronic kidney disease Wang Liyuan， Liu Shuangxin， Cui Yanhai， Zeng Rui， Huang Jinlong， Zhi Qisheng.Guangzhou Social Welfare Institute， Guangzhou 510520， China

Corresponding author， Cui Yanhai， E-mail： yanhai_cui@ 126. com

【Abstract】Objective To evaluate the changes of bone mineral density after subtotal parathyroidectomy in patients with secondary hyperparathyroidism after maintenance hemodialysis for chronic kidney disease. Methods Clinical data of 33 patients with chronic kidney disease undergoing subtotal parathyroidectomy after secondary hyperparathyroidism following hemodialysis （operation group） and 37 patients with the same diseases receiving drug therapy alone（drug group） were collected. All patients received chest CT scan before and after corresponding treatment. The changes of bone calcium score of the sternum were measured by CT scan serum calcium， serum phosphorus， parathyroid hormone and bone mineral density were statistically compared between two groups. The relationship between operation and changes of bone mineral density was analyzed. Results In the operation group， serum calcium， serum phosphorus， parathyroid hormone and bone mineral density had statistical significance before and after treatment （all P < 0.05）， and bone mineral density was increased. The serum calcium， serum phosphorus， parathyroid hormone and bone mineral density did not significantly differ before and after treatment in the drug group （all P > 0.05）. After the adjustment of age， operation was significantly correlated with the changes of bone mineral density （P < 0.05）. Conclusion Subtotal parathyroidectomy contributes to improving bone mineral density in patients with chronic kidney disease and secondary hyperparathyroidism after hemodialysis.

【Key words】Chronic kidney disease;Bone mineral density;Hyperparathyroidism;

Computed tomography

继发性甲状旁腺功能亢进（SHPT）是慢性肾脏病（CKD）血液透析治疗患者常见的并发症，其可导致一系列的矿物质代谢异常，从而引发相应的临床症状，降低患者生存质量或引起其他严重并发症，例如骨折等[1-3]。有研究显示，对接受血液透析治疗的患者行甲状旁腺切除术，不仅可以改善患者的贫血以及营养不良状态，还可以有效地缓解患者的临床症状，是一种安全、有效的治疗手段，相较于药物治疗效果更持久、复发率更低[4-5]。近年来越来越多研究也显示，CKD致SHPT患者骨密度低与骨折风险密切相关[6-7]。但是，目前尚未有充足的临床数据反映CKD合并SHPT患者甲状旁腺切除术后骨密度的变化。笔者拟通过CT定量测量骨钙积分的方法，观察需接受维持性血液透析的CDK合并SHPT患者甲状旁腺次全切除术前后骨密度的变化情况。……