甲状旁腺切除对血液透析患者心血管钙化影响的初步探讨

目的观 察甲状旁腺切除术（PTX）对伴有继发性甲状旁腺功能亢进症（Secondary Hyperparathyroidism,SHPT）的血液透析患者钙磷代谢以及动脉钙化、动脉僵硬度情况的影响.方法 选取21例有继发性甲状旁腺功能亢进的血液透析患者,行甲状旁腺切除术,对患者术前、术后1年应用多层螺旋CT检测冠状动脉钙化积分,并测臂踝脉搏波传导速度（baPWV）,同时将患者术前、术后1年的血钙、血磷、钙磷乘积、PTH等指标进行比较.结果 与术前比较,术后1年患者冠状动脉钙化积分有明显减低（P=0.0236）,左右两侧肢体臂踝脉搏波传导速度（baPWV）平均值减少（=0.0034,P=0.0012）,差异性有统计学意义;术后血钙、血磷、钙磷乘积、PTH水平均明显降低,差异性有统计学意义（P分别为0.0004,0.0002,0.0000,0.0000）.结论 甲状旁腺切除术（pTx）能纠正钙磷代谢紊乱,减轻动脉钙化程度,改善动脉僵硬度.

Impact of parathyroidectomy on cardiovascular calcification in maintenance hemodialysis patients

Objective To observe the impact of parathyroidectomy （PTX） on calcium and phosphorus metabolism, arterial calcification and arterial stiffness in maintenance hemodialysis （MHD） patients complicated with secondary hyperparathyroidism （SHPT）. Methods A total of 21 MHD patients with SHPT were subjected to PTX. Their coronary artery calcification score based on the multi-slice spiral CT images, brachial-ankle pulse wave velocity （baPWV）, serum calcium, phosphorus, calcium-phosphorus product, and serum PTH were compared before PTX and after PTX for one year. Results After PTX for one year, coronary artery calcification score decreased significantly （P=0.0236）, so did the mean baPWVs of bilateral limbs （P=0.0034 and 0.0012 for left and right limbs, respectively）, as compared with those before PTX. Serum calcium, phosphorus, calcium-phosphorus product, and PTH also reduced after PTX （P=0.0004, 0.0002, 〈0.0001 and 〈0.0001, respectively）. Conclusions PTX improved calcium and phosphorus metabolism, and reduced arterial calcification and stiffness in MHD patients with SHPT.