不同手术方式治疗继发性甲状旁腺功能亢进对肾性贫血的疗效观察简

目的 探讨不同手术方式治疗尿毒症继发性甲状旁腺功能亢进（SHPT）对肾性贫血的临床疗效.方法 回顾性分析尿毒症SHPT患者30例,根据手术方式不同,分A、B、C3组,每组10例.A组采取甲状旁腺切除术（PTX）＋自体前臂肱桡肌种植移植,B组采取PTX＋自体前臂皮下注射移植,C组采取甲状旁腺全切除不移植术（TPTX）.观察术前、术后第3、6、12个月时患者的全段甲状旁腺激素（iPTH）、血红蛋白（Hb）、血细胞比容（Hct）,同时记录患者促细胞生成素用量.结果 三组患者术前血清iPTH水平均较高,但组间差异无统计学意义（P〉0.05）.三组患者术后自第3个月起iPTH水平均显著下降（P〈0.01）,至第6个月起一直维持在理想水平.从3个月起C组与A、B组间差异显著（P〈0.01）.三组术后Hb及Hct均逐步上升,至第12个月时较术前都达到统计学差异（P分别〈0.01和0.05）.C组与A、B组相比贫血显著改善（P〈0.05）.三组患者手术前促红细胞生成素用量组间比较无统计学差异（P〉0.05）,手术后促红细胞生成素用量逐步减少,至第6个月时均达统计学差异（P〈0.01）.C组与A、B组相比第6个月时促红细胞生成素用量减少达统计学意义（P〈0.05）.结论 PTX＋自体前臂肱桡肌种植移植、PTX＋自体前臂皮下注射移植及TPTX三种手术方案治疗尿毒症SHPT均可迅速降低iPTH水平并显著改善肾性贫血、减少促红细胞生成素用量.TPTX在纠正肾性贫血及减少促红细胞生成素用量方面优于前两种手术方式.

Observation on different surgical methods for secondary hyperparathyroidism on renal anemia

Objective To explore the clinical efficacy on renal anemia with different modes of operation in treatment of secondary hyper- parathyroidism （SHPT） caused by uremia. Methods A retrospective analysis had been carried out in 30 patients with uremia caused SHPT. Ac- cording to different surgical methods, these patients were randomly divided into A, B and C groups, patients in group A were treated by PTX plus autolagous forearm brachioradialis muscle planting transplant, patients in group B were treated by FIX plus autologous forearm subcutaneous injec- tion transplantation and patients in group C were treated by TPTX, 10 cases in each group. Hemoglobin （Hb） and hematokfit （Hot） were ob- served in patients with iPTH before operation and in third, sixth and twelfth months after operation. At the same time, the dosage of erythrepoietin had been recorded. Results The level of serum iPTH was higher in patients of these 3 groups, but there was no statistically significant difference among these groups. Since three months after operation, the data of patients in three groups regarding levels of iPTH were significantly decreased （ P 〈0.01 ）, and remained in the ideal level after six months. Since three months, the difference according to iPTH level of group C compared with that of group A and group B was significant （ P 〈0.01 ）. The data of Hb and Hct had been gradually increased in patients of 3 groups after operation till 12 months, it had statistical difference compared with those of pre -operation （ P 〈 0.01 and 0.05 ）. The anemia in group C com- pared with groups A and B had significantly been improved （ P 〈 0.05 ）. The dosage of erythrepoietin before surgery in these 3 groups had no sta- tistical difference, the dosage of erythropoietin had gradually been reduced after operation till to 6 months, and the difference in dosage of erythre- poietin was statistically significant （ P 〈 0.01 ）. Conclusion Three kinds of surgery including PTX with autologous forearm braehioradialis mus- cle planting transplantation, PTX with autologous forearm subcutaneously injection transplantation and TP＇rX can quickly lower the level of iPTH and significantly improve renal anemia, and reduce the dosage of erythrepoietin. The method of TPTX in correcting renal anemia and reducing the dosage of erythropeietin is better than other two kinds of operation modes.