继发性甲状旁腺功能亢进的治疗策略

继发性甲状旁腺功能亢进(SHPT)已成为慢性肾脏病(CKD)常见的并发症之一，严重影响患者生活质量。其治疗策略包括药物、手术和介入。药物包括非选择性和选择性活性维生素D、拟钙剂(西那卡塞)，药物治疗期间强调动态观察血清全段甲状旁腺激素(iPTH)和血清钙、磷的变化，以及时调整药物剂量。药物治疗无效且具备手术指征者，可考虑甲状旁腺切除手术(PTX)或超声介入治疗。PTX前需要高频彩超和(或)⁹⁹Tc^m-MIBI双时相显像用于甲状旁腺的定位诊断。PTX有三种术式，其中甲状旁腺全切除加移植是目前最常用的术式。对于不能耐受手术和需要再次PTX的患者可以选择一种新的治疗策略，即彩色超声介导下甲状旁腺热消融术。

Strategy for the treatment of secondary hyperparathyroidism

Secondary hyperparathyroidism (SHPT) has become one of the most common complications of chronic kidney disease (CKD), and seriously affects the patients′ quality of life, whose treatment strategy consists of medication, surgery, and intervention. Its medications include non-selective and selective active vitamin D and cinacalcet, during which the changes of serum intact parathyroid hormone (iPTH), calcium, and phosphorus are monitored, so that the doses of drugs can be timely adjusted. When medical treatment is ineffective and the patient has the indication for surgery, parathyroidectomy (PTX) or ultrasound interventional therapy can be considered. High frequency color ultrasound and/or ⁹⁹Tc^m-MIBI dual-phase scintigraphy are/is required for the preoperative localization diagnosis of parathyroid. There are three parathyroidectomy methods, among which total parathyroidectomy plus autotransplantation is currently the most-used surgical method. Color ultrasound-guided thermal ablation of parathyroid gland may be used as a new treatment strategy for patients who can′t tolerate PTX or requires a second PTX.