Total parathyroidectomy with forearm autograft in the treatment of uremic patients with secondary hyperparathyroidism

Objective To analyze the efficacy and safety of total parathyroidectomy (PTX) with forearm autograft in uremic patients with secondary hyperparathyroidism (SHPT). Methods One hundred and eighteen cases undergoing PTX with forearm autograft in our hospital from 2001-2010 were included in this study. Their preoperative and postoperative serum intact parathyroid hormone (iPTH), biochemistry tests (total calcium,inorganic phosphate and alkaline phosphate) were collected and postoperative symptom relief, complications and recurrence were investigated. Results Of all the 118 cases, 32 underwent endoscopic surgery and 86 open surgery. The surgery was performed successfully in 110 cases (93.2%) and one case died in perioperative period. Thyroid carcinoma was diagnosed during surgery in 2 cases and radical operation was performed at the same time. Temporary injury of recurrent laryngeal nerve was found in nine cases (7.6%). Postoperative hypocalcemia was frequently seen in 108 cases (91.5%) and it was effectively controlled by postoperative calcium administration. After operation, bone pain and itching were alleviated, and weakness, anemia and malnutrition status were improved in all the cases who received successful surgery. The postoperative levels of serum iPTH (P＜0.01), calcium (P＜0.01), phosphorus (P＜0.01) and calcium×phosphorus (P＜0.01) were decreased significantly than those in preoperative period. A long-term follow-up of over 3 years was carried out in 21 cases. Six cases recurred, among them, 4 cases relieved after removal of autografted parethroid tissue, and another two cases received the second operation. The longest follow-up period lasted for 9 years in two cases without recurrence. Conclusions PTX with forearm autograft is safe and effective in the treatment for uremic patients with SHPT. No severe complication is found during the long-term follow-up period.     

维持性血液透析患者血清脂联素与左心室肥厚的相关性分析

目的探讨维持性血液透析（MHD）患者血清脂联素（ADPN）水平与左心室肥厚（LVH）的相关性。方法选择我院MHD患者79例,行心脏超声心动图测定左心室舒张末期内径（LVDd）、左心室收缩末期内径（LVDs）、室间隔厚度（IVST）、左心室后壁厚度（LVPwT）、左心室射血分数（EF）,计算左心室质量指数（LVMI）。按照LVMI值将79例MHD患者分成LVH组和非LVH组,选择同期健康者16名为对照组。测定3组血清ADPN、血糖、胰岛素、血脂、C反应蛋白（CRP）,计算体重指数（BMI）、稳态模型胰岛素抵抗指数,分析血液透析患者血清ADPN水平与上述参数及LVH之间的相关性。结果LVH组和非LVH组的血清ADPN均高于对照组,LVH组血清ADPN低于非LVH组,而胰岛素、胰岛素抵抗指数、CRP高于对照组和非LVH组;MHD患者血清ADPN与胰岛素、胰岛素抵抗指数、CRP、LVMI呈明显负相关,胰岛素抵抗指数、CRP与LVMI呈明显正相关。结论MHD患者血清ADPN水平与慢性炎症及胰岛素抵抗关系密切,可能共同参与了LVH的发生和发展。     

甲状旁腺全切除自体前臂移植术治疗肾功能不全继发性甲状旁腺功能亢进

目的:研究甲状旁腺全切除(PTX)自体前臂移植术治疗慢性肾功能衰竭继发性甲状旁腺功能亢进(SHPT)的疗效和安全性。方法:回顾性分析2011年12月—2015年12月接受PTX自体前臂移植的30例慢性肾功能衰竭终末期并SHPT患者的临床资料,观察患者术后临床症状改善情况、血清全段甲状旁腺激素(iPTH)、钙、磷及钙磷乘积的变化,以及术后并发症与复发情况。结果:所有患者均手术成功。术后患者临床症状均明显改善;血清iPTH、钙、磷及钙磷乘积水平均较术前明显降低(均P0.05)。12例患者出现一过性喉返神经损伤,均自行好转。术后8例(2.7%)复发,7例再次手术后症状缓解。结论:PTX自体前臂移植术是治疗慢性肾功能衰竭SHPT的一种安全有效的方法。     

高通量血液透析联合左卡尼汀对尿毒症心肌病的临床研究

目的 高通量血液透析联合左卡尼汀对尿毒症心肌病的影响.方法 选取81例于本院门诊和住院部透析的患者,随机分成两组:实验组41例,对照组40例,所有患者均每周3次血液透析,每次4h,实验组自2012年10月开始接受高通量血液透析联合左卡尼汀治疗,对照组进行单纯的高通量血液透析治疗,两组患者都观察8个月.治疗前后检测血红蛋白、血细胞比容,做常规超声心动图,观察左心室舒张期末内径(LVIDd)、左心室收缩末期内径(LVIDs)、室间隔舒张期末期厚度(IVSd)、左室心肌质量(LVM)、左室心肌质量指数(LVMI)、左室后壁厚度(PWTH)、射血分数(EF)、左心室的舒张功能(EPSS)等.结果 治疗8个月后,实验组患者的血红蛋白、血细胞比容与对照组比较明显升高(P＜0.05),超声心动图EF值明显升高,LVIDd、LVIDs、IVSd、PWTH、LVM、LVMI明显降低,差异均有统计学意义(P＜0.05).结论 高通量血液透析联合左卡尼汀在改善尿毒症心肌病患者心肌重构及心功能方面有较好的疗效.     

甲状旁腺全切除加前臂移植治疗尿毒症继发性甲状旁腺功能亢进

目的观察甲状旁腺全切除(PTX)加自体前臂移植术治疗尿毒症维持性透析患者严重继发性甲状旁腺功能亢进(SHPT)的临床疗效。方法回顾性分析我院12例接受PTX加自体前臂移植术的患者资料,包括术前B超定位与手术切除的甲状旁腺定位的关系,以及术前后血甲状旁腺激素(iPTH)、血钙磷、红细胞比容(Hct)、甘油三酯、透析充分性(Kt／V、UUR)的变化。结果 11例患者术中所切除的甲状旁腺结节与术前B超定位完全一致,1例患者在手术探查中新发现1个较小的约0．5 cm3甲状旁腺结节。术后血钙、磷及其乘积较术前明显下降,差异有统计学意义。术后各时间点(1周、1、3、6、12个月)血iPTH较术前明显下降,差异有统计学意义。术后3个月甘油三酯[(1．78±0．61)mmol／L]较术前[(2．07±0．47)mmol／L]明显下降,Hct (0．31±0．06)较术前(0．26±0．05)明显提高;透析充分性Kt／V、UUR(1．668±0．173、0．696±0．041)较术前(1．567±0．195、0．667±0．054)升高,差异均有有统计学意义。结论甲状旁腺全切除加自体前臂移植能有效治疗SHPT,可以改善患者的贫血及脂质代谢紊乱,提高部分患者的透析耐受性而改善透析充分性。术前颈部甲状旁腺B超定位指导手术是可行的方法之一。避免术后复发的关键是做到真正的甲状旁腺全切除及选取适量的弥漫增生的甲状旁腺行自体前臂移植。     

Time-dependent changes in cardiac growth after kidney transplantation: the impact of pre-dialysis ventricular mass.

BACKGROUND: Left ventricular hypertrophy (LVH) is common in chronic kidney disease (CKD), including kidney transplant recipients. However, time-related left ventricular mass changes (DeltaLVM) from pre-dialysis stage to beyond the first post-transplant year have not been clearly identified. METHODS: We studied a cohort of 60 stages 4-5 CKD patients without overt cardiac disease, who underwent three echocardiograms during follow-up: at pre-dialysis stage, on dialysis and after kidney transplantation (KT). Multiple linear regression was used to model DeltaLVM from baseline study. Cox proportional analysis was used to determine risk factors associated with either de novo LVH or>20% DeltaLVMI over time. RESULTS: Patients with baseline LVH (n=37; 61%) had a higher body mass index (BMI) than those without LVH (n=23; 39%) (P=0.013). BMI, haemoglobin levels (P=0.047) and non-use of angiotensin-converting enzyme inhibitors (ACEI) (P=0.057) were associated with baseline left ventricular mass index (LVMI). Twelve out of 23 patients (52%) with normal LVM at baseline, developed either de novo LVH or>20% DeltaLVMI at follow-up. On the other hand, 29 (78%) of those with initial LVH maintained this abnormality, and 8 (22%) normalized LVM post-transplantation. Factors associated with DeltaLVMI were age (P=0.01), pre-dialysis LVMI (P<0.0001), serum creatinine (P=0.012) and the use of ACEI post-transplantation (P=0.009). In Cox analysis, pre-dialysis LVMI was associated with de novo LVH or>20% DeltaLVMI over time (hazard ratio 1.009; 95% confidence interval 1.004 to 1.015; P=0.001). CONCLUSIONS: Successful KT may not completely normalize LVM post-transplantation. Pre-dialysis LVMI, traditional risk factors and no use of ACEI may perpetuate cardiac growth following KT.     

Assessment of left ventricular mass regression after aortic valve replacement--cardiovascular magnetic resonance versus M-mode echocardiography.

OBJECTIVE: In patients with aortic valve disease, the presence of left ventricular hypertrophy (LVH) carries a significant risk of adverse cardiovascular events. Regression of hypertrophy after aortic valve replacement (AVR) is associated with a reduction in risk. In general, M-mode echocardiography has been used for quantitative assessment of left ventricular mass (LVM) and regression, but this technique is believed to have limitations from which cardiovascular magnetic resonance (CMR) does not suffer. The objective of this study therefore was to determine whether quantitative assessment of LVM and regression after AVR using the two techniques was comparable. METHODS: Thirty-nine patients with aortic valve disease were studied before and 1 year after AVR. Transthoracic M-mode echocardiography and four different formulae were used to calculate left ventricular mass index (LVMI), and then compared with CMR measurements. RESULTS: Overall, correlation between the techniques for single measurement of LVMI was moderate (r-values from 0.64 to 0.69), with a tendency for overestimation by echocardiography; there was no agreement in degree of regression (r-values from 0.004 to 0.18). The Bland-Altman limits of agreement ranged from 85 to 131% for single measurement of LVMI, and 328-470% for regression. The change in LVMI with CMR was 43+/-28 g/m2, vs. 27 to 54+/-19 to 41 g/m2 using echocardiography. CONCLUSIONS: M-mode echocardiography does not provide reliable quantification of regression of LVH in individuals, and for accurate measurement CMR is superior. The use of CMR in future studies may reduce costs since fewer subjects are needed to accurately detect significant changes in LVMI after AVR.     

甲状旁腺全切加前臂移植治疗难治性肾性甲状旁腺功能亢进的疗效观察

目的 观察甲状旁腺全切加前臂移植术（PTX+AT）治疗慢性肾脏病（CKD）患者严重继发性甲状旁腺功能亢进(SHPT)的临床疗效。方法 选择我院2011年2月~2012年7月难治性肾性SHPT行PTX+AT术并随访3个月以上的20例患者。观察手术前后甲状旁腺激素(iPTH)、血钙、磷、血红蛋白、相关临床症状的变化情况。结果 （1）20例患者顺利完成手术,18例患者行甲状旁腺全切加前臂移植术,2例患者术中仅发现并切除3枚甲状旁腺,未行前臂移植。（2）无一例出现手术并发症（喉神经损伤、呼吸困难、抽搐等）。所有患者术后第2天骨痛、皮肤瘙痒、乏力等临床症状均明显改善。（3）术后各时间点血钙、磷、iPTH较术前明显下降,术后3月红细胞压积（Hct）较术前显著提高,差异均有统计学意义。结论 PTX+AT对于治疗难治性肾性SHPT疗效明确,是一种安全、经济和有效的治疗手段,术前甲状旁腺的准确定位及术后及时调整血钙水平是治疗成功的关键。     

肾性与原发性高血压患者左心室肥厚及功能变化的比较研究

目的比较肾性高血压患者和原发性高血压患者左心室肥厚及功能的变化。方法采用超声心动图检查30例肾性高血压患者及20例年龄、性别、血压相匹配的肾功能正常的原发性高血压患者,观察左心室肥厚及重量指数（LVMI）、左心室射血分数（EF）及左心室等容舒张时间（IVRT）和E／A比值。结果30例肾性高血压患者左室肥厚发生率、LVMI、IVRT高于原发性高血压患者,E／A比值低于原发性高血压患者,EF值无显著差异,肾性高血压患者存在明显的钙磷代谢紊乱、继发性甲状旁腺功能亢进症和贫血,其LVMI与血红蛋白呈显著负相关,而与血清全段甲状旁腺激素（iPTH）呈显著正相关。结论肾性高血压患者左心室肥厚程度及左心室舒张功能障碍较原发性高血压患者严重,除高血压外,贫血及继发性甲状旁腺功能亢进亦应受到重视。     

维持性血液透析患者脂肪因子和胰岛素抵抗与心脏结构及功能的相关分析

目的 探讨维持性血液透析患者脂肪因子(脂联素、瘦素)、胰岛素抵抗水平与心脏结构和功能的相关性.方法 选择79例维持性血液透析患者和16名健康对照者,测定血清脂联素、瘦素、血糖、胰岛素并计算稳态模型胰岛素抵抗指数;行超声心动图测定左心房内径、左心室舒张末内径、左心室收缩末内径、室间隔厚度、左心室后壁厚度、左心室射血分数等,计算左心室心肌重量指数,并将维持性血液透析患者分成左心室肥厚组(43例)和非左心室肥厚组(36例).结果 维持性血液透析组患者的血清脂联素、瘦素、胰岛素、稳态模型胰岛素抵抗指数与健康对照组比较差异有统计学意义(P<0.05);维持性血液透析组左心室心肌重量指数、左心室舒张末内径、室间隔厚度、左心室后壁厚度、左心房内径、舒张早期和晚期最大血流速度比、左心室射血分数与健康对照组比较差异也有统计学意义(P分别<0.05、0.01).维持性血液透析组左心室肥厚的发生率为54.4%,左心室射血分数<50%的发生率为10.2%、舒张早期和晚期最大血流速度比<1的发生率为71.9%;左心室肥厚组的血清瘦素、胰岛素、稳态模型胰岛素抵抗指数、左心室心肌重茸指数、血清脂联素与非左心室肥厚组比较差异有统计学意义(P分别<0.05、0.01).维持性血液透析组患者血清脂联素与血清瘦素、胰岛素、稳态模型胰岛素抵抗指数、左心室心肌重量指数、室间隔厚度、左心室后壁厚度呈显著负相关(r分别=-0.770、-0.693、-0.530、-0.483、-0.374、-0.320,P分别<0.05、0.01);血清瘦素与胰岛素、稳态模型胰岛素抵抗指数呈显著正相关(r分别=0.620、0.620,P均<0.01);血清瘦素、胰岛素、稳态模型胰岛素抵抗指数分别与左心室心肌重量指数、室间隔厚度、左心室后壁厚度呈显著正相关(r分别=0.513、0.381、0.149、0.617、0.359、0.293、0.483、0.359、0.320,P分别<0.05、<0.01);血清瘦素、胰岛素、稳态模型胰岛素抵抗指数分别与舒张早期和晚期最大血流速度比、左心室射血分数呈负相关(,分别=-0.225、-0.111、-0.215、-0.750、-0.198、-0.049,P均<0.05).结论 维持性血液透析患者脂肪因子(血清脂联素、瘦素)与胰岛素抵抗密切相关,并相互协同共同参与了维持性血液透析患者心血管并发症的发生和发展.     

腹膜透析患者左室肥厚的相关因素分析

目的探讨腹膜透析患者左心室肥厚的发生情况及相关影响因素。 方法选取2012年9月至2013年9月在广西医科大学第一附属医院腹膜透析中心随访的腹膜透析患者89人,规律腹膜透析6个月以上。排除标准：近一个月有腹膜炎或其他部位感染史,合并有急性心衰、慢性阻塞性肺疾病、恶性肿瘤、急性心脑血管病变、风湿性心脏病、严重肝功能不全及近3个月内使用糖皮质激素及免疫抑制剂的患者。采集入选病例临床资料,并予心脏彩超检查,通过测量室间隔厚度(LVST)、左心室厚度(LVPWT)、左室舒张内径(LVEDD)计算左心室心肌重量指数(LVMI)。左室肥厚定义为LVMI男性≥115 g/m²,女性≥95 g/m²。分析患者的横断面资料,并将患者分为左室肥厚组及非左室肥厚组进行比较。采用SPSS 17.0统计软件进行数据分析。两变量相关分析用Pearson(正态资料)或Spearman(非正态资料)相关分析。左室肥厚的独立危险因素分析用二分类Logistic回归分析,P<0.05认为差异有统计学意义。 结果89例患者中,男女比为1.47∶1,年龄(48.49±12.27)岁,腹膜透析龄(25.35±24.30)个月。病因：慢性肾小球肾炎61例(68.54%)、高血压肾病16例(17.98%)、糖尿病肾病2例(2.25%)、其他病因10例(11.24%)。左心室肥厚66例(74.16%)。将左心室肥厚组与非左心室肥厚组的相关指标进行比较。两组患者的血脑利钠肽前体(NT-proBNP)、腹膜透析液肌酐与血中清肌酐比值(D/P)、血白蛋白、左室射血分数(LVEF)、LVEDD、左室收缩末期内径(LVESD)、左房内径(LAD)、LVPWT及LVST等差异有统计学意义(P<0.05)。左心室肥厚与NT-proBNP、D/P值、LVEDD、LVST、LAD、LVESD及LVPWT呈正相关(P<0.05),与LVEF呈负相关(r＝－0.222,P＝0.036)。NT-proBNP水平是左室肥厚的独立危险因素(B偏回归系数0.001,SE值：0.000,Wals值：13.45,95%CI为1.000～1.001, P<0.001)。 结论腹膜透析患者较易发生左心室肥厚,其左心室肥厚与营养状态、容量负荷及腹膜转运类型等相关,NT-proBNP水平有望成为腹膜透析患者左室肥厚的评估预测生物标志物。     

早期慢性肾病患者动态血压变化与左心室肥厚的关系

目的：分析早期慢性肾脏病（CKD1期）患者24h动态血压变化与左心室肥厚（LVH）的关系。方法：以25例正常人作为对照组（N组）,71例肾功能稳定的CKD1期患者作为疾病组（D组）。收集肾功能、血脂、24h动态血压监测（ABPM）等临床资料;采用超声心动图检测早期CKD患者LVH有关指标,分析ABPM指标与LVH的关系。结果：（1）与N组相比,D组夜间收缩压,昼、夜及24h平均舒张压均升高（P均〈0.05）;夜间收缩压下降率（nDRS）及舒张压下降率（nDRD）均明显下降（P均〈0.05）;舒张末期左室内径（LVDd）及左心室质量指数（LVMI）均升高（P均〈0.05）。（2）D组高血压及非杓型血压发生率分别达47.9%、62.0%。（3）与杓型血压组（Dip组）相比,非杓型血压组（non-Dip组）LVMI值及LVH发生率均显著增高（P均〈0.05）。（4）与非高血压组（non-LVH组）相比,高血压组（LVH组）nDRS和nDRD均明显下降,血红蛋白（Hb）显著降低（P均〈0.05）。（5）相关性分析显示LVMI值与nDRS、nDRD和Hb均呈负相关（P均〈0.01）,昼间平均收缩压（dSBP）、夜间平均收缩压（nSBP）、夜间平均舒张压（nDBP）和24h平均舒张压（mSBP）均呈正相关（P均〈0.05）。多因素逐步回归分析显示：nDRS、Hb、nDRD和血肌酐（Scr）进入回归方程：y=123.429-2.290x1-0.47x2-0.768x3＋0.178x4（y=LVMI;123.429=常数,t=8.41,P=0.000;x1=nDRS,t=-5.43,P=0.000;x2=Hb,t=-4.77,P=0.000;x3=NDRD,t=-3.47,P=0.001;x4=Scr,t=2.08,P=0.041）。结论：早期CKD患者即已出现血压升高及血压节律改变;LVH发生与早期CKD患者夜间高血压及非杓型血压关系更为密切;贫血和肾功能减退本身也与早期CKD患者LVH发生有关。     

The relationship between indoxyl sulfate and left ventricular hypertrophy in hemodialysis patients

Objective To investigate the relationship between indoxyl sulfate (IS) and left ventricular hypertrophy (LVH) in hemodialysis patients. Methods For the eligible patients (age ≥18 years, dialysis duration > 6 months, without history of congestive heart failure within 3 months and comorbidity of cardiac aneurysm), clinical data were collected, biochemical measurements were completed, and echocardiographic examinations were performed. Plasma IS concentration was determined by high performance liquid chromatography electrospray tandem spectrometry (HPLC-ESI-MS/MS). Linear and Logistic regression models were employed to assess the associations of plasma IS and left ventricular mass index (LVMI) and LVH, respectively. Results Two hundred and ten hemodialysis patients (117 males) with mean age of（57.2 ± 14.3）years were enrolled. The prevalence of LVH was up to 64.0%. Univariate linear regression showed that plasma IS was positively correlated with LVMI (β=7.09, P=0.02). The result persisted after adjustment for all kinds of risk factors (β=4.16, P=0.03). Patients were categorized into two groups: LVH and non-LVH group. Logistic regression models were employed to assess the relationship of plasma IS and LVH. The result showed that plasma IS was independently associated with LVH after adjustment for other confounding risk factors (β=6.54, OR=1.13, 95%CI 1.09-1.44, P=0.03). Conclusions LVH is prevalent in hemodialysis patients. Plasma IS is significantly correlated with LVMI and the independent risk factor for LVH.     

Improved left ventricular mass index in children after renal transplantation

Left ventricular hypertrophy (LVH) is a risk factor for cardiovascular disease, and it is prevalent in children with end-stage renal disease (ESRD) and after renal transplantation (RTx) on cross-sectional studies. Our aim was to compare prospectively left ventricular mass index (LVMI) in children with ESRD, before and after RTx. Thirteen patients aged 1.5-15 years underwent echocardiogram prior to and at least 3 months after RTx, and again in the second year after transplantation. A control group consisted of children with ESRD who remained on dialysis. Systolic and diastolic blood pressure index decreased significantly over the study period only in the children who had undergone RTx. Mean LVMI in children with ESRD decreased from 45.4 +/- 12.6 g/m(2.7) to 34.9 +/- 10.4 g/m(2.7) after RTx (P = 0.001), but it remained unchanged in patients who remained on dialysis. The prevalence of LVH decreased from 54% to 8% (P = 0.03) after RTx. Systolic and diastolic blood pressure index were correlated with LVMI. Mean body mass index increased during the study period from 17.3 +/- 2.5 to 20 +/- 4.6 (P = 0.05); however, no correlation was found with LVMI. LVH in children with ESRD is potentially reversible after RTx, especially with good control of hypertension.     

糖尿病肾病致终末期维持性血液透析患者的心脏结构及功能特点分析

目的：探讨糖尿病致终末期维持性血液透析患者的心脏结构及功能的特点分析.方法：选择上海市第六人民医院血液透析中心接受规律血液透析3年以上的糖尿病肾病MHD患者47例,并收集临床一般资料和生化指标.所有患者在治疗前及治疗3年后均进行心脏彩超检查,采用Sonos5500型二维彩色多普勒超声仪,S4探头,M型方法检测,测定左心室舒张末期内径（LVDd）、左心室收缩末期内径（LVDs）、左心房内径（LAD）、左心室后壁厚度（LVPWT）、室间隔厚度（IVST）、左心室射血分数（LVEF）、二尖瓣前向血流E峰与A峰比值（E/A）,根据Devereux公式计算左心室心肌质量指数（LVMI）.结果：（1）比较治疗前后左心室肥大（LVH）的发生比率,LVDd、LVDs、LVPWT及LVMI值,结果发现,治疗后要高于治疗前,而LVEF较治疗前降低,说明随着透析龄的增长,心脏结构发生改变,心功能进一步恶化,甚至出现心功能衰竭.（2）比较治疗前后P、CaP、hs-CRP及Pro-BNP发现,治疗后明显要高于治疗前,且与心脏结构和功能密切相关,尤其是与LVMI呈正相关,与LVEF呈负相关;另外,还与LVEDd、LVEDs、LAD、LVPWT、IVST及E/A存在相关,说明钙磷代谢紊乱、微炎症状态及高Pro-BNP与糖尿病肾病MHD患者心脏结构和功能密切相关,是导致左心室肥大的重要危险因素.结论：糖尿病肾病MHD患者普遍存在左心室肥大,而且随着透析龄的增长,这种现象更为严重.高磷血症、高钙磷乘积、Hs-CRP及pro-BNP与心脏结构和功能改变关系密切.     

Risk factors of left ventricular hypertrophy in non-dialysis dependent end-stage renal disease patients

Objective To investigate the risk factors of left ventricular hypertrophy (LVH) in non-dialysis dependent end-stage renal disease (ESRD) patients. Methods ESRD patients in the First Affiliated Hospital of Sun Yat-sen University from Jan to July 2019 were enrolled. Demographic data of patients were collected and biochemical parameters were measured. Hydration status index (extracellular water/total body water, ECW/TBW) was measured by bioelectrical impedance analysis (BIA), and LVH was diagnosed by echocardiography. Patients were divided into LVH group and non-LVH group according to LVH diagnostic criteria, and the incidence of LVH in ESRD non-dialysis patients was calculated. Logistic regression was used to analyze the risk factors of LVH. Results A total of 105 non-dialysis dependent ESRD patients aged (47.03±12.56) years (21-78 years) were enrolled in present study, among whom 74 patients (70.5%) had LVH. Compared to non-LVH group, patients in LVH group had higher proportion of diabetes and calcium antagonist used, higher value of ECW/TBW and ECW/Height, higher level of night systolic pressure, and were older (all P＜0.05). Spearman correlation analysis showed LVH was positively correlated to diabetes (r=0.345, P＜0.001), night systolic pressure (r=0.286, P＜0.001), night diastolic pressure (r=0.251, P=0.012), calcium antagonist used (r=0.381, P=0.013), ECW/TBW (r=0.383, P=0.005), ECW/Height (r=0.298, P=0.003), 24 h sodium urinary excretion (r=0.257, P=0.025), brain natriuretic peptide (r=0.315, P=0.005) and hemoglobin (r=0.307, P=0.018), and negatively correlated to 24 h potassium urinary excretion (r=-0.248, P=0.023). Logistic regression showed that increased night diastolic pressure (OR=2.036, 95%CI 1.144-3.623, P=0.016) and ECW/TBW (OR=1.232, 95%CI 1.025-1.523, P=0.014）were the independent risk factors of LVH after adjusting for gender, age, diabetes, nocturnal blood pressure, antihypertensive drugs used, ECW/TBW, urinary sodium excretion and hemoglobin. Conclusions LVH is common in non-dialysis dependent ESRD patients. Over hydration and high night diastolic blood pressure are the independent risk factors of LVH in non-dialysis dependent ESRD patients.     

Bone metabolism markers and hungry bone syndrome after parathyroidectomy in dialysis patients with secondary hyperparathyroidism

Objective

To explore the short-term variation in bone metabolic markers and the characteristics of hungry bone syndrome (HBS) after parathyroidectomy (PTX) with forearm autotransplantation in uremic patients with secondary hyperparathyroidism (SHPT) and to provide a basis for the pathogenesis, diagnosis and treatment of metabolic bone disease in SHPT.

Methods

A total of 115 patients with SHPT receiving PTX from July 2015 to December 2017, hospitalized at the First Affiliated Hospital of Nanjing Medical University, were enrolled in our study. We retrospectively analyzed the baseline clinical data, the levels of bone metabolism markers before and on the third day after PTX, and the risk factors predicting HBS.

Results

Preoperative baseline data showed that the levels of bone metabolic markers such as bone metabolism-regulating hormones: iPTH, calcitonin (CT); bone formation markers: phosphatase (ALP), osteocalcin (OC); bone resorption markers: type I collagen cross-linked N-telopeptides (NTX), type I collagen cross-linked C-telopeptides (CTX), tartrate-resistant acid phosphatase 5b (TRAP-5b) were all increased compared to normal levels. The levels of postoperative serum iPTH, CT, CTX and TRAP-5b decreased significantly compared to preoperative levels, while the levels of OC and ALP increased significantly. Of the 115 patients, 101 (87.8%) developed HBS after PTX. High preoperative serum ALP and low preoperative serum calcium level independently predicted the occurrence of HBS. Younger preoperative age, high preoperative serum ALP and iPTH level independently predicted the severity of HBS.

Conclusions

In severe SHPT, both bone formation and resorption were active, which suggested the presence of high-turnover bone diseases characterized by up-regulation of osteoclasts-osteoblasts functionally coupling activation in the patients. PTX could promote osteoblast activity and reduce osteoclast activity. HBS was common after PTX. Preoperative higher serum ALP and lower calcium were independent predictors of the occurrence of HBS. Younger patients with higher preoperative ALP and PTH may need to closely monitor serum calcium levels and intensive calcium supplementation after PTX.

     

维持性血液透析患者钙磷代谢及透析龄与左心室心肌质量指数的关系

目的:探讨维持性血液透析患者钙磷代谢及透析龄与左心室心肌质量指数的关系。方法:研究对象为上海市第六人民医院血液透析中心接受维持性血液治疗1年以上的102例患者,按血磷分为高磷组(Pi>1.78 mmol/L,n=72)和对照组(Pi:1.13 mmol/L~1.78 mmol/L,n=30);按钙磷乘积分为对照组(钙磷乘积≤55 mg2/dl2,n=47)和高钙磷乘积组(钙磷乘积>55 mg2/dl2,n=55);按透析龄分为A组(透析龄1~5年,n=61)和B组(透析龄>5年,n=41)。用超声心动图测定左心室舒张末内径(LVDd)、左心室收缩末内径(LVDs)、左房内径(LAD)、左心室后壁厚度(LVPWT)、室间隔厚度(IVST),并收集临床指标。结果:(1)将血磷、钙磷乘积及透析龄与反应心脏结构的指标(LVDd、LVDs、LAD、IVST、LVPWT、LVMI)进行相关性分析,结果发现维持性血液透析患者心脏结构的改变与钙磷代谢及透析龄密切相关。另外,钙磷乘积和透析龄与FS存在相关性。(2)高磷组LVDd、LVDs及LVMI与对照组比较,其差异均有统计学意义(P<0.05),说明高磷血症患者出现左心室肥大。(3)高钙磷乘积组的LVDd、LVDs及LVMI与对照组比较,其差异均有统计学意义(P<0.05),说明钙磷乘积升高组,左心室肥大较对照组显著。(4)两组患者比较LVH发生比率,结果显示,B组要高于A组(71.89%vs37.78%,P=0.045),差异有统计学意义。A组LVDd、LVDs、LVPWT、LVMI及FS与B组比较,其差异均有统计学意义(P<0.05),说明随着透析时间的增长,心脏结构的改变越来越明显,左心室肥大的发生率越来越高。结论:维持性血液透析患者普遍存在心脏结构的改变,随着透析龄的增加,心脏结构和功能进一步恶化。钙磷代谢及透析龄影响心脏结构改变,最终导致心功能衰竭。     

Effect of erythropoietin therapy on red cells filterability and left ventricular mass in predialysis patients

BACKGROUND: Cardiovascular complications are the leading cause of mortality in patients with end-stage renal disease. Left ventricular hypertrophy (LVH) is recognized as an independent risk factor for cardiovascular morbidity and mortality. At the onset of dialysis, more than 70% of the patients with chronic kidney disease have echocardiographic evidence of LVH. Anemia, increased red cells filterability time (RCFT), and blood viscosity are known to induce LVH. AIM: To evaluate, prospectively, the effects of erythropoietin (EPO) therapy for 20 weeks on RCFT and left ventricular mass (LVM). PATIENTS AND METHODS: Twenty uremic and anemic predialysis patients with creatinine clearance test below 35 mL/min were studied. RCFT test and three-dimensional echocardiography were performed at 0, 10, and 20 weeks. RESULTS: EPO therapy for 20 weeks did not adversely affect renal function and did not significantly change the mean blood pressure. It significantly increased the hemoglobin and fibrinogen levels, and decreased RCFT and LVM (p < .01). CONCLUSION: Although correction of anemia can contribute to regression of LVM, we speculate that an increasing number of cells with normalized viscoelastic properties and a direct effect of EPO on erythrocytes and myocardiocytes, through specific receptors, may also play an important role.     

Impact of amlodipine or ramipril treatment on left ventricular mass and carotid intima-media thickness in nondiabetic hemodialysis patients

Objective: Left ventricular hypertrophy (LVH) and atherosclerosis are frequently observed in uremic patients and they have appeared as an independent predictor of cardiovascular morbidity and mortality. The aim of this study was to compare the effects of ramipril and amlodipine on left ventricular mass index (LVMI) and carotid intima-media thickness (CIMT) in nondiabetic hypertensive hemodialysis patients. Methods: A total of 112 hemodialysis (HD) patients were included in this study. Patients were randomly allocated to receive ramipril or amlodipine for 1 year. Blood pressure (BP) measurements, LVMI, and CIMT were assessed at baseline and 6-month intervals. Biochemical parameters and inflammatory markers were also determined at the initiation and during the study period. Results: Similar BP decrease was observed in treatment groups. During follow-up, LVMI and CIMT progressed likewise in both treatment groups despite BP control. However, subgrouping analyses due to the pattern of left ventricular geometry showed that LVMI in patients with eccentric LVH increased, whereas LVMI decreased in subjects with concentric LVH under antihypertensive treatment. Discussion: BP control with ramipril or amlodipine could not provide adequate protection for development or progression of atherosclerosis and eccentric type of LVH in nondiabetic HD patients.