钙三醇对尿毒症继发甲状旁腺功能亢进血液透析患者血压的影响

尿毒症患者血压常增高,且不易控制,往往需要联合应用多种降压药物,但部分患者血压控制仍不理想。自１９９８年５月至２０００年２月我们对２１例尿毒症继发甲状旁腺机能亢进（ＳＨＰＴ）且血压控制不理想的血液透析（ＨＤ）患者应用钙三醇注射剂治疗,结果显示患者血清甲状旁腺激素（ｉＰＴＨ）水平下降,同时血压得到较好控制。现报道如下。 资料与方法 １．一般情况：２１例均为尿毒症并ＳＨＰＴ（血清ｉＰＴＨ水平增高）维持性ＨＤ患者,ＨＤ时间２～２２个月。长期应用降压药物,而血压控制不理想即收缩压≥１４０ｍｍＨｇ和（或）舒…     

纳米碳对甲状旁腺切除加自体移植术中甲状旁腺识别作用探讨

目的探讨纳米碳对甲状旁腺切除加自体移植术中甲状旁腺识别作用。方法尿毒症继发性甲状旁腺功能亢进病人74例,分为观察组(39例)和对照组(35例)。观察组采取纳米碳术中示踪的甲状旁腺切除加自体移植术;对照组采取传统的甲状旁腺切除加自体移植术;随访6个月,观察手术结果、病理诊断、血清甲状旁腺激素(PTH)、血钙水平、并发症及复发情况。结果两组术后症状均较术前明显改善;观察组甲状旁腺组织切除准确率为100%,对照组为86.18%,差异有统计学意义(P0.05);两组手术切口长度、术中出血量差异均无统计学意义(P0.05);观察组手术时间、术后住院时间短于对照组,差异有统计学意义(P0.05);观察组术后1天及6个月时血清PTH、血钙水平低于对照组,差异有统计学意义(P0.05);两组均未见喉返神经损伤。观察组术后出现低血钙20例,对照组术后均出现不同程度的低血钙,经对症处理后缓解;随访期间,观察组复发率为0,对照组为11.43%,差异有统计学意义(P0.05)。结论纳米碳对甲状旁腺切除加自体移植术中异常甲状旁腺有识别作用,有助于保护甲状腺功能和喉返神经。     

不同钙浓度透析液对血液透析患者钙磷代谢的影响

终末期肾衰竭伴有甲状旁腺功能亢进患者常常使用大剂量含钙的磷结合剂，应用高钙（1．75mmol／L）透析液等治疗，导致钙负荷增高，引起软组织、血管和心脏钙化，增加患者死亡率。孙鲁英等曾报道单次使用低钙（1．25mmol／L）透析液的疗效，但长期使用低钙透析对患者的影响报道甚少。为此，我们连续6个月分别使用两种钙浓度的透析液，观察其对患者血压、钙、磷和PTH的影响。     

61例尿毒症患者甲状旁腺全切加前臂移植术后低钙血症的发生与处理

目的针对内科治疗无效的继发性甲状旁腺功能亢进（sHPT）的尿毒症患者行甲状旁腺全切加前臂移植术,分析术后患者低钙血症的发生与处理。方法61例患者术后立即监测血钙浓度,并静脉补充葡萄糖酸钙,使血钙维持在1．8～2．2mmol／L之间,统计手术前、后患者的全段甲状旁腺激素（iPTH）、血清钙磷乘积和碱性磷酸酶（AKP）水平以及手术切除的总的腺体质量。结果56例患者（占91．7％）术后12-24h即出现血钙低于1．8mmol／L,静脉立即补充葡萄糖酸钙,约合元素钙（18±6）g,补钙剂量与术前血iPTH（r=0．621,P〈0．01）、钙磷乘积（r=0．719,P〈0．01）、AKP（r=0．606,P〈0．01）及总的切除腺体质量（r=0．716,P〈0．01）相关。结论低钙血症是患者甲状旁腺术后的常见表现,与SHPT的严重程度有关,术后及早监测血钙和静脉补钙可有效、安全预防严重低钙血症的发生。     

甲状旁腺次全切除术和甲状旁腺全切除加甲状旁腺自体移植术治疗尿毒症后继发性甲状旁腺功能亢进的疗效

目的 比较尿毒症后继发性甲状旁腺功能亢进（SHPT）行甲状旁腺次全切除术（sPTX）和甲状旁腺全切除（tPTX）加甲状旁腺自体移植（AT）术的疗效。方法 回顾性分析2005年2月至2012年9月期间中国人民武装警察部队新疆生产建设兵团指挥部后勤部医院及新疆维吾尔自治区人民医院行tPTX＋AT （n=57）和sPTX （n=19） 的76例尿毒症后SHPT患者的临床资料,比较2种术式的疗效。结果 76例患者手术成功68例（89.5%）,切除不足8例（10.5%）。76例患者术后骨痛均缓解,皮肤瘙痒症状改善14例（26.9%,14/52）。tPTX＋AT组术后1 d、7 d及6个月的血钙水平均较低（P＜0.05）,术后6个月的iPTH水平较低（P＜0.05）。2组患者的手术时间、术中出血量、住院时间及住院费用比较差异均有统计学意义,tPTX＋AT组均较长或较高（P＜0.05）。术后76例患者均获访,随访时间为6～18个月,中位数为8.7个月。其中tPTX＋AT组死亡2例,复发2例;sPTX组死亡1例,复发7例。sPTX组的复发率较高（P＜0.05）。结论 尿毒症后SHPT行tPTX＋AT的术后1年内复发率较低,行sPTX者更易发生术后复发;但tPTX＋AT组的手术时间、术中出血量、住院时间及住院费用更高（更长或更多）。 2种术式各有优劣,术式选择时需根据情况综合判定。     

低钙透析液对腹膜透析患者钙磷代谢的影响

目的横断面研究腹膜透析患者使用低钙透析液的安全性及其影响因素。方法选择西安交通大学医学院第一附属医院肾脏内科腹膜透析超过6个月的患者共39例，其中男24例，女15例，年龄56．49±19．31岁，其中使用常规（ca 1．75mmol／L）透析液8例，低钙（ca 1．25mmol／L）透析液31例，比较两组血清钙、磷、甲状旁腺激素、血压以及使用碳酸钙的情况。结果两组血钙无明显差异；常规透析液组血磷和钙磷乘积高于低钙组，两组iPTH无明显差异。低钙组服用碳酸钙剂量明显高于常规透析液组。低钙组服用碳酸钙与未服用碳酸钙血钙无明显差异，服用碳酸钙组血磷控制较为理想、钙磷乘积更接近正常，未服用碳酸钙组血PTH明显升高。结论腹膜透析患者使用低钙透析液有利于控制血磷和血压，有效预防钙磷乘积升高。提高对碳酸钙的依从性是预防使用低钙透析液后引起继发性甲状旁腺功能亢进的关键。     

残余肾功能对血液透析患者钙磷代谢的影响

目的观察不同残余。肾功能状态对维持性血液透析患者钙磷代谢的影响。方法将维持性血液透析患者80例,按照残余肾小球滤过率（residual glomerular filtration rate,rGFR）分为A组[rGFR〉2ml·min-1·（1．73rn2）。331例、B组[rGFR〈2ml·min-1·（1．73m2）-1]49例。比较2组空腹血钙、血磷、钙磷乘积、甲状旁腺素（parathyroid hormone,PTH）的差异。结果与B组比较,A组血磷、钙磷乘积、PTH低,且差异有统计学意义（P〈0．05）;2组血钙浓度无统计学差异（P〉0．05）。结论残余肾功能可有效的纠正维持性血液透析患者的钙磷代谢紊乱,临床上应重视残余肾功能在调节钙磷代谢异常方面的积极作用,保护好维持性血液透析患者的残余肾功能。     

肾移植术后继发性甲状旁腺功能亢进的临床分析

目的研究肾移植术后合并甲状旁腺功能亢进的受者血清钙、磷代谢及免疫反应性甲状旁腺激素(iPTH)水平的变化趋势,探讨治疗方式的选择。 方法回顾性分析2012年1月至2014年6月在解放军第三〇九医院全军器官移植研究所泌尿外科因尿毒症行肾移植、且术前并发继发性甲状旁腺功能亢进(SHPT)、术后移植肾功能恢复至估算肾小球滤过率(eGFR)>60 mL·min^－1·(1.73 m²)^－1的受者资料。共179例受者纳入研究,平均年龄(34±6)岁(18～61岁),术前慢性肾脏病分级均为5级。肾移植术后常规应用骨化三醇治疗(0.25 μg,1次/d),维持正常血清钙、磷水平。记录肾移植前后受者血清钙、磷及iPTH水平。采用单因素重复测量资料方差分析比较肾移植前和移植后1周、1个月、6个月、12个月和24个月受者血清钙、磷、iPTH水平,采用χ²检验比较低磷血症和高钙血症发生率以及iPTH分布情况。 结果肾移植术后1个月受者血清钙上升至稳定期,同时血清磷下降至稳定期;术后6个月高钙血症和低磷血症发生率最高,分别为8.4%(15/179)和9.5%(17/179)。术后1～6个月受者iPTH下降明显,随后无明显变化,术后24个月仅有27%(48/179)的受者iPTH水平降至完全正常。 结论尿毒症患者行肾移植术后,SHPT均有所缓解,但大部分无法恢复至正常水平,术后需要进行积极的针对性治疗。     

血液透析患者甲状旁腺全切除加上臂移植术后低钙血症的防治

目的 观察因继发性甲状旁腺功能亢进症（secondary hyperparathyroidism,SHPT）进行甲状旁腺全切除加上臂移植术（total parathyroidectomy with upper arm autograft,TPTX＋AT）的血液透析患者,术后使用不同钙离子浓度的透析液行透析治疗低钙血症的效果,探讨如何更有效防治术后低钙血症.方法 选择2011年3月至2013年6月在我院接受TPTX＋AT的血液透析患者29例,按照手术时间的先后顺序进行编号,随机将偶数分在A组14例,奇数分在B组15例.术前B组补钙及骨化三醇;术后2组均予补钙及骨化三醇.A组使用钙浓度1.50 mmol/L透析液,B组使用钙浓度1.75 mmol/L高钙透析液.观察术后8 h、24 h、48 h、1周、2周及4周的血钙、血磷及甲状旁腺素（intact parathyroid hormone,iPTH）的变化,记录低钙血症的临床症状,术后达到治疗目标所需要的时间及静脉补钙量.结果 术后血钙、血磷、iPTH均明显下降.术后低钙血症主要表现四肢末端发麻,全身无力,焦虑、烦躁;少数患者表现为心悸、多汗、肌肉痉挛、四肢抽搐,血压低、腹痛或腹泻.A组低钙血症发生率为 85.7%（12/14）、B组为 73.3%（11/15）.术后1周B组血钙水平[（1.95±0.18）mmol/L]明显高于A组[（1.76±0.21）mmol/L].B组术后达到治疗目标所需要的时间为[（7.56±2.25）d],少于A组[（10.54±3.12）d];而B组所需静脉补钙量[（6.86±2.13）g]少于A组[（9.28±2.81）g],差异均有统计学意义（P＜0.05）.结论 并发SHPT的血液透析患者在TPTX＋AT术后常会出现低钙血症,术前、术后足量补充钙剂和骨化三醇,术后使用高钙透析液透析能更加有效防治低钙血症.     

钙通道阻滞剂对尿毒症患者血浆甲状旁腺素和钙磷代谢的影响

目的观察钙通道阻滞剂对尿毒症患者血甲状旁腺激素（PTH）和钙磷代谢的影响。方法选择本院血液透析患者共128例。根据用药情况分为4组：对照组、钙通道阻滞剂组、活性维生素D制剂组、钙通道阻滞剂＋活性维生素D制剂组。所有患者每个月常规检测透析前静脉血PTH,血清钙（Ca^2＋）、磷（P^3-）等。结果钙通道阻滞剂能促使甲状旁腺异常分泌PTH,与活性维生素D制剂合用则降低活性维生素D制剂抑制PTH分泌的效果,同时有引起高钙血症的可能。结论对肾衰竭患者使用钙通道阻滞剂不但能促使甲状旁腺分泌PTH,而且有致高钙血症危险。     

邯郸地区应用生理钙透析液对持续性腹膜透析患者钙磷代谢的影响

目的观察邯郸地区持续性腹膜透析患者随腹膜透析时间延长,应用生理钙透析液(Dianeal PD4)对其血钙、血磷及全段甲状旁腺素(intact parathyroid hormone,iPTH)水平的影响。方法回顾性分析2006年2月至2014年3月在我院住院首次诊断为终末期肾脏疾病(end-stage renal disease,ESRD)并行持续性不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPE))治疗大于12个月的77例资料完整患者的临床资料,在应用生理钙透析液(钙浓度为1.25 mmol/L)进行维持性腹膜透析,并配合口服碳酸钙及骨化三醇条件下,观察透析后3、6、12个月血钙、血磷、iPTH、碱性磷酸酶(alkaline phosphatase,ALP)和血白蛋白、总白蛋白、尿素氮、肌酐、尿酸等各项生化指标水平,分析透析前后校正血钙、血磷、iPTH、ALP等指标变化情况,同时观察患者使用生理钙透析液有无低血压、抽搐、不宁腿、瘙痒等不适。结果患者血钙、磷、尿素、肌酐、尿酸、白蛋白、血红蛋白在生理钙透析液透析后3、6、12个月与透析初始比较,差异均有统计学意义(P0.05),而透析后3、6、12个月之间比较,差异均无统计学意义(P0.05)。患者iPTH在腹透开始后逐渐上升,但在透析后3、6个月与透析前比较,差异无统计学意义(P0.05),而透析12个月后与透析前比较差异有统计学意义(P0.05)。患者ALP和总白蛋白水平在透析前后无明显变化。结论邯郸地区应用生理钙透析液进行维持性腹膜透析的患者,在配合口服钙剂及活性维生素D制剂情况下,可有效改善患者钙磷代谢紊乱,从而防治继发性甲状旁腺功能亢进症及肾性骨病的发生。     

Effect of parathyroidectomy on anemia and cardiac function in uremic patients with secondary hyperparathyroidism

Objective To explore the effect of total parathyroidectomy (PTX) with forearm autograft on the anemia and cardiac function in uremic patients with secondary hyperparathyroidism (SHPT). Methods The clinical data of 130 uremic patients who received PTX with forearm autograft in the First Affiliated Hospital of Zhejiang University from October 2010 to December 2015 were retrospectively analyzed. The changes of anemia and echocardiogram before and after operation were compared. According to the presence of left ventricular hypertrophy (LVH) before operation, the patients were divided into LVH group and non-LVH group. Echocardiographic indexes before and one year after operation of the two groups were compared. Results (1) Three months and one year after operation, hemoglobin and hematocrit increased while erythropoietin average usage decreased significantly (P＜0.01). (2) Compared with preoperative period, the dry weight was significantly increased one year after operation, and the cardiac function indexes including left ventricular end diastolic diameter (LVDd), interventricular septum end diastolic thickness (IVSd), left ventricular posterior wall end diastolic thickness (LVPWd), interventricular septum systolic thickness (IVSs), left ventricular systolic diameter (LVDs), left ventricular myocardial mass (LVM), and left ventricular myocardial mass index (LVMI) decreased significantly (P＜0.05). (3) In the non-LVH group, only IVSs decreased one year after operation (P＜0.05). In the LVH group, LVDs, LVDd, LVPWd, LVM, LVMI and IVSs were decreased significantly one year after operation than those in preoperative period (P＜0.05). Conclusions PTX with forearm autograft is an effective treatment for uremic patients with SHPT significantly improving anemia and left ventricular structure and function, especially for patients with ventricular hypertrophy in preoperative.     

原发性甲状旁腺功能亢进手术治疗对骨代谢影响的研究

目的观察原发性甲状旁腺功能亢进（PHPT）患者手术治疗后症状、体征改善情况、骨代谢指标及骨量变化.方法将31例PHPT患者分为3组：绝经后妇女组、绝经前妇女组和男性组.手术前后分别检测血及尿骨代谢生化指标和骨密度测量.结果①术后3个月开始骨痛明显减轻直至消失,骨骼畸形和行走困难均有不同程度缓解;②3组患者术后半年骨量都明显增加,1年时达到最高,2年时男性组及绝经前妇女组骨量基本维持不变,绝经后妇女组骨量开始减少.骨量增加的部位以腰椎最为明显,股骨次之,前臂骨量变化较缓慢;③术后绝大部分患者骨代谢指标均达正常范围.结论PHTP如不及时治疗对骨骼的危害极大,尽早手术可减轻原发性甲状旁腺功能亢进对骨骼的影响,提高患者的生活质量.     

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。     

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.     

Effects of percutaneous ethanol injection therapy on subsequent parathyroidectomy

BACKGROUND: Although percutaneous ethanol injection therapy (PEIT) is an alternative to surgery for patients with secondary or tertiary hyperparathyroidism, it also has been conjectured to make subsequent parathyroidectomy more difficult. METHODS: The records of 37 patients with end-stage renal disease managed between September 2000 and August 2005 were reviewed retrospectively. All patients had hyperparathyroidism intractable to medical treatment, and all eventually underwent parathyroidectomy. Of the 37 patients, 20 initially underwent PEIT, whereas 17 did not. Surgical and biochemical outcomes were compared between the 2 groups. RESULTS: i-PTH and biochemical markers before and after surgery did not differ significantly between the 2 groups, nor did the outcome, defined as persistent hypocalcemia, persistent hyperphosphatemia, persistent low or high i-PTH, persistent hoarseness, or residual parathyroid mass. Parathyroidectomy in the PEIT group proceeded smoothly and was not hindered by inflammation or tissue adhesion. CONCLUSIONS: Using PEIT to treat hyperparathyroidism in patients with end-stage renal disease does not make subsequent parathyroidectomy more difficult.     

维持性血液透析患者钙磷代谢紊乱的影响因素及其与肾性贫血的相关性

目的调查我院血液透析中心患者钙磷代谢标志物血钙、血磷、全段甲状旁腺素(intact parathyroid hormone,iPTH)等指标的达标情况,探讨维持性血液透析患者钙磷代谢紊乱的影响因素及其与肾性贫血的关系,以便更好的控制钙磷代谢紊乱并管理贫血。方法研究纳入2010年1月至2015年1月在我院血液透析中心规律行血液透析(透析时间≥3个月)的终末期肾病患者作为研究对象,收集患者年龄、性别、透析时间、透析频率、残余尿量等相关资料及患者血钙、血磷、iPTH、血红蛋白(hemoglobin,Hb)等实验室检查指标,统计我院血液透析中心患者钙磷代谢标志物血钙、血磷、iPTH等各项指标的达标情况。然后分别根据年龄、透析龄、透析频率、残余尿量进行分组,比较各组间钙磷代谢指标的差异性,再分别根据血钙、血磷和iPTH进行分组,采用趋势卡方检验及方差分析比较各组间Hb达标情况。结果①本血液透析中心263例患者中,血钙达标率45.0%,血磷达标率40.1%,iPTH达标率23.7%,与透析预后与实践模式研究第4阶段(Dialysis Outcomes and Practice Pattern Study,DOPPS4)国家达标数据(56.0%、54.5%、32.1%)比较,达标率存在一定差距。②根据透析龄进行分组,透析龄≥3年组平均血钙水平显著高于透析龄3年组平均血钙水平;根据透析频率进行分组,每周2次透析组平均血钙水平显著高于每周≤2次透析组平均血钙水平,血磷水平显著低于每周≤2次透析组。根据残余尿量进行分组,有尿组(尿量≥100 rnl/24 h)钙磷乘积显著低于无尿组。根据年龄分组,年龄45岁组平均血磷水平、iPTH水平、钙磷乘积水平显著低于年龄≤45岁组。③将血钙浓度分为2.1 mmol/L、2.1~2.5 mmol/L、2.5 mmol/L三组。随着血钙增高,Hb达标(≥110 g/L)人数占比越来越大,由38.8%上升至64%,差异有统计学意义(P0.05)。将血磷浓度分为1.13 mmol/L、1.13~1.78 mmol/L、1.78 mmol/L三组,随着血磷增高,Hb达标(110 g/L)人数占比越来越大,由31%上升至53.4%,差异有统计学意义(P0.05)。将血iPTH浓度分为150 ng/L、150~300 ng/L、300 ng/L三组。随着iPTH增高,Hb达标(≥110 g/L)人数占比越来越小,由52.8%下降至36.8%,差异有统计学意义(P0.05)。结论①适当增加透析频率及有效保护残余尿量有助于控制及改善钙磷代谢紊乱。②血钙、血磷浓度上升,有利于维持性血液透析患者Hb的达标。血iPTH浓度上升,不利于维持性血液透析患者Hb的达标。     

继发性甲状旁腺功能亢进患者术后临床评估

目的探讨继发性甲状旁腺功能亢进患者行甲状旁腺全切除或次全切除术后的预后。方法选择2009年1月至2012年12月在深圳市人民医院行慢性肾替代治疗合并继发性甲状旁腺功能亢进症手术治疗后的88例患者进行1~4年随访观察。术中留取血液样本送检测全段甲状旁腺素(immunoreactive parathyroid hormone,iPTH)水平(电化学发光法),根据测定的iPTH水平,由外科医生决定手术方式为次全切除或全切除术。根据手术方法将88例患者分为次全切除组和全切除组。次全切除组64例,男35例,女29例;全切除组24例,男女各12例;比较2组患者术后的复发率及预后。另外根据术后随访及血清iPTH的检测,将88例患者复发分为复发组和未复发组。复发组11例,男6例,女5例;未复发组77例,男41例,女36例;应用Log-rank检验对复发情况进行分析,并对可能影响复发的因素进行分析。结果 88例患者进行了(21±11.3)个月的随访研究,复发患者术后第2天iPTH水平(111.20±81.4)ng/L高于未复发患者iPTH(24.4±35.8)ng/L,2组比较有统计学差异(t=-3.486,P0.01);随访期间次全切除组10人复发,全切除组1人复发,经Log-rank检验不同手术组的未复发率无统计学差异(χ~2=0.33,P=0.57)。全部88例患者术后第12、26、36个月累积未复发率分别为98.8%、91.3%及67.1%。结论维持性透析继发性甲状旁腺功能亢进患者行甲状旁腺全切除或次全切除术后的1~4年内复发率无显著差异,术后患者症状明显改善,术后第二天的iPTH水平可能与复发相关。     

Relationship between dietary phosphorus intake and nutritional status and calcium and phosphorus metabolism in patients with chronic kidney disease

Objective To evaluate the dietary phosphorus intake of non-dialysis patients with chronic kidney disease (CKD) 3-5 stage, and to explore the relationship between dietary phosphorus intake, nutritional status, and calcium and phosphorus metabolism. Methods A cross-sectional study was conducted. Non-dialysis patients of CKD 3-5 stage in Huashan Hospital outpatient clinic were selected. Three-day dietary diaries, anthropometric indicators, subjective global assessment (SGA) scores, blood and 24-hour urine biochemical indicators were collected. According to the median dietary phosphorus intake (873 mg/d), the patients were divided into high phosphorus intake group (≥ 873 mg/d) and low phosphorus intake group (＜873 mg/d). The differences of characteristics, anthropometric indicators, SGA scores, blood and urine biochemical indicators between the two groups were compared. Multivariate linear regression analysis was used to analyze the correlation between dietary phosphorus intake and different kinds of food intake. Results A total of 118 patients were enrolled. The daily energy intake was (25.48±4.45) kcal/kg, protein intake was (0.88±0.22) g/kg and phosphorus intake was (862.85±233.02) mg/d. There were no significant differences in body mass index and SGA scores between high phosphorus intake group and low phosphorus intake group. The waist circumference, hip circumference, waist-hip ratio and leg circumference of male patients in high phosphorus intake group were higher than those in low phosphorus intake group (all P＜0.05). There were no significant differences in anthropometric indicators between the two groups of female patients. The serum levels of intact parathyroid hormone (iPTH), sodium, triglyceride, blood RBC count, alanine aminotransferase, 24-hour urine urea nitrogen, 24-hour urine creatinine and 24-hour urine phosphate in the high phosphorus intake group were higher than those in the low phosphorus intake group (all P＜0.05). Multivariate regression analysis showed that pork and chicken contributed the most to dietary phosphorus intake, followed by fish and dairy. Conclusions The daily dietary phosphorus intake of non-dialysis of CKD 3-5 stage patients is slightly higher than the recommended intake. The increase of dietary phosphorus intake may lead to the increase of serum iPTH and sodium levels. Proper control of dietary phosphorus intake will not impair the nutritional status of CKD patients.