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1.
目的 回顾性总结维持性血液透析患者继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)行甲状旁腺切除术(parathyroidectomy,PTX)的临床疗效.方法 收集2009年10月~2013年11月的25例血液透析患者(平均透析龄58±18.7个月;平均年龄45.6±8.3岁).监测术后并发症及复发情况.对比分析患者术前及术后1个月、3个月、6个月的临床症状、全段甲状旁腺激素(intact parathyroid hormone,iPTH)、血清钙、血清磷及碱性磷酸酶等变化.结果 25例患者中,甲状旁腺全切术共24例(占96%),甲状旁腺全切加前臂自体移植术1例(占4%).术后围手术期无死亡发生.术后绝大部分患者的骨痛及皮肤瘙痒症状在数天内缓解,但随着随访时间的延长,术前颈部彩色超声示小于4枚甲状旁腺结节性增大的5例患者骨痛症状均有复发(20%),但程度较术前明显减轻.2例患者出现一过性声音嘶哑(发生率8%).术后全部患者均出现低钙血症(发生率100%),经积极补钙治疗后均可有效控制.25例患者术前均表现为明显增高的iPTH、血清钙、血清磷和ALP.术后iPTH(P<0.01)、血清钙(P<0.01)、血清磷(P<0.01)和ALP(P<0.01)水平均较术前显著降低.随访6个月,5例复发(20%),且均为术前检查小于4枚甲状旁腺结节性增大的患者.结论 PTX治疗维持性血液透析患者继发性甲旁亢是一种相对安全和有效的方法,但其长期疗效仍有待于进一步观察.  相似文献   

2.
目的:观察甲状旁腺全切加自体前臂移植术(total parathyroidectomy with forearm autograft,PTX+AT)对维持性血液透析(maintenance hemodialysis,MHD)合并难治性继发性甲状旁腺功能亢进(secondary hyperparathyroidism,S...  相似文献   

3.
目的 观察甲状旁腺切除术(parathyroidectomy,PTX)对继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)的维持性血液透析患者骨代谢及骨密度(BMD)的影响.方法 26例SHPT患者行PTX.术前及术后1、3、6、12、18、24个月时常规检测血钙、血磷、血清碱性磷酸酶,化学发光法检测血清全段甲状旁腺素(intact parathyroid,iPTH)、骨钙素(OC)、Ⅰ型前胶原氨基末端前肽(PINP)、β胶原蛋白(β-C TX),术前及术后24个月时双能X线法测定腰椎、股骨颈、骨盆各部位骨密度,观察患者甲状旁腺切除术前、术后骨代谢指标及骨密度变化.结果 (1)与术前比较,血清OC水平[(104.49±25.42) μg/L比(695.46±355.62) μg/L,P< 0.01]、PINP水平[(248.36±159.38) μg/L比(809.28±283.50) μg/L,P<0.01]于手术3个月后明显降低,β-CTX水平于手术1个月后明显降低[(1.60±0.64) μg/L比(3.37±1.34) μg/L,P<0.01].(2)与术前比较,术后24个月时腰椎BMD[(0.88±0.23) g/cm2比(0.78±0.23) g/cm2,P<0.01]、股骨颈BMD[(0.96±0.19) g/cm2比(0.84±0.24) g/cm2,P< 0.01]及腰椎Z评分[(-1.24±0.55)比(-1.66±0.24),P<0.01]、股骨颈Z评分[(-1.51±0.72)比(-1.93±0.40),P<0.01]均升高.(3)相关分析显示,术前血清iPTH水平与⊿腰椎Z评分(r=0.584,P=0.002)、⊿股骨颈Z评分(r=0.400,P=0.043)呈正相关,术前血清OC水平与⊿腰椎Z评分(r=0.651,P<0.001)、⊿股骨颈Z评分(r=0.509,P=0.008)呈正相关.结论 PTX术可以降低患者升高的iPTH、OC、PINP及β-CTX水平,增加骨密度,同时改善多项生化指标,提高患者生活质量.  相似文献   

4.
目的:探讨帕立骨化醇治疗维持性血液透析患者继发性甲状旁腺机能亢进症的效果。方法:筛选2021年5月至2021年8月首都医科大学附属北京朝阳医院血液净化科收治的维持性血液透析继发性甲状旁腺机能亢进症患者20例(全段甲状旁腺素500~2 000 pg/ml),予帕立骨化醇治疗,每次5 μg,每周3次,后续根据血清全段甲状旁...  相似文献   

5.
目的 本研究调查维持性血透患者的睡眠质量和日间嗜睡状况,探讨影响睡眠质量的相关因素。 方法 112例维持性高通量血透患者和53例健康人对照进行匹兹堡睡眠质量指数(PSQI)问卷评估睡眠质量和Epworth Sleep Scale(ESS)问卷评估日间嗜睡程度,并比较结果。比较睡眠好(PSQI总分≤5)和睡眠差(PSQI总分>5)的患者PSQI 7部分得分及各种睡眠障碍的原因;观察不同时间段血透患者的睡眠情况;多元线性回归和logistic回归分析年龄、透析龄等临床基本资料以及血钙、磷、血红蛋白等生化指标与睡眠质量的相关性。 结果 血透患者PSQI总分高于对照组(7.02±4.94比3.28±2.79,P < 0.05),而ESS总分低于对照组[3(0~6)比8(4.25~11.75),P < 0.05]。58%的血透患者睡眠差,入睡时间明显延长(30 min比15 min,P < 0.05),失眠是主要原因。早、中、夜班血透睡眠质量无显著差异。年龄(OR = 1.75,P = 0.003)、透析龄(OR = 1.26,P = 0.008)、血红蛋白(OR = 0.64,P = 0.008)、钙磷乘积(OR = 1.60,P = 0.02)与睡眠质量评分显著相关。 结论 血透患者普遍存在睡眠不良,老年、透析龄长、贫血、钙磷乘积升高是危险因素。  相似文献   

6.
目的 观察帕立骨化醇治疗维持性血液透析患者继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)的疗效及安全性.方法 选择我科血液净化中心进行维持性血液透析治疗的13例患者,血全段甲状旁腺素(intact parathyroid hormone,iPTH)≥33 pmol/L,血钙水平<2.55 mmol/L,钙磷乘积<65,根据iPTH水平使用帕立骨化醇1~18 μg治疗,于每次透析治疗后给药,共观察12周.分别于治疗前及治疗后第2、4、6、8、10、12周测定患者的iPTH、血钙、血磷水平.结果 13例患者的血清iPTH水平在治疗后第2、4周已开始下降,但与治疗前相比差异无统计学意义.从治疗后第6周开始,iPTH水平与治疗前相比存在统计学差异(P<0.05),治疗后第12周时下降至(46.68±38.06) pmol/L,与治疗前(78.30±52.13) pmol/L比较,有统计学差异(P<0.01).治疗后第2、4周血钙水平升高,与治疗前比较有统计学差异(P<0.05),其中治疗后第4周时血钙水平升高尤为显著(P<0.01).经调整帕立骨化醇剂量后,治疗后第6周患者的血钙水平逐渐恢复正常并保持稳定,血磷、钙磷乘积水平在治疗前、后均无明显统计学差异.治疗过程中,患者耐受性良好,无相关不良反应的发生.结论 使用帕立骨化醇治疗维持性血液透析患者SHPT是有效、安全的.  相似文献   

7.
目的:探讨西那卡塞联合小剂量骨化三醇治疗维持性血液透析(MHD)合并继发性甲状旁腺功能亢进(SHPT)的疗效观察。方法:选取本院肾病中心2012年8月至2017年8月收治的80例MHD合并SHPT患者,采用随机数字表法将其分为骨化三醇组和联合治疗组,每组各40例。骨化三醇组采用骨化三醇治疗,联合治疗组采用西那卡塞联合小...  相似文献   

8.
目的了解广东省贫困地区血液透析人群矿物质及骨代谢异常的流行病学情况。方法在广东省特困县梅州市五华县进行横断面调查。检测维持性血液透析患者的生化指标和全段甲状旁腺激素,访谈式问卷调查患者对矿物质及骨代谢异常的知晓情况和饮食习惯。结果调查46例患者,年龄(46±11)岁,均为客家人,80.4%为农村人口,中位透析时间35月,每2周中位透析次数4次。根据K/DOQI指南推荐标准,本组对象中41.3%血钙达标,但血磷和全段甲状旁腺激素分别只有6.5%和19.6%达标,没有3项指标同时达标的患者。在43例完成问卷调查的患者中,知晓甲状旁腺激素、肾性骨病、低磷饮食和药物降磷的比例分别为44.2%、55.8%、53.5%和69.8%;有喝肉汤习惯、没有控制肉类摄入、饮奶制品习惯和进食豆类习惯的比例分别为58.1%、46.5%、28.3%和21.7%。结论广东省贫困地区透析人群中防治矿物质及骨代谢异常的工作开展仍不充分。经济和医疗条件落后、健康宣教不足、患者遵医依从性低以及客家地区特殊的饮食习惯是这一地区开展矿物质及骨代谢异常健康管理面临的挑战。  相似文献   

9.
目的 探讨帕立骨化醇注射液联合低钙透析治疗维持性血液透析患者高血钙并继发性甲状旁腺功能亢进症(SHPT)的安全性及疗效,为SHPT的临床治疗提供更多的选择方案.方法 选择郴州市第一人民医院血液净化中心2019年1月至2019年12月收治的符合条件的规律血液透析患者24例,所有入组患者均给予低钙透析(透析液钙离子浓度1....  相似文献   

10.
目的观察帕立骨化醇对维持性血液透析患者继发性甲状旁腺功能亢进症的治疗效果。方法选择2018年7月至2019年7月对非选择性维生素D受体激动剂(VDRA)疗效不佳或不能耐受拟钙剂或不愿手术治疗的继发性甲状旁腺功能亢进(SHPT)的维持性血液透析患者56例,根据血液全段甲状旁腺素(iPTH)水平将所有患者分为三个组别:A组(300 pg/mL≤iPTH<600 pg/mL)、B组(600 pg/mL≤iPTH<800 pg/mL)、C组(iPTH≥800 pg/mL)。根据体重给予不同剂量的静脉帕立骨化醇注射液,分别检测患者治疗前、初始使用1个月以及达到帕立骨化醇维持剂量时,iPTH、血钙、血磷、钙磷乘积的变化情况。结果患者骨痛、瘙痒、疲乏等症状明显改善。所有患者初始治疗1个月,iPTH达标率为51.8%(29/56),达到帕立骨化醇注射液维持治疗剂量百分比为57.1%(32/56)。患者初始治疗1个月与治疗前相比,iPTH水平显著下降[(718.76±457.56)pg/mL vs.(956.68±375.61)pg/mL,P<0.001],血钙、血磷以及钙磷乘积无明显改变[(2.28±0.23)mmol/L vs.(2.23±0.27)mmol/L,(2.15±0.49)mmol/L vs.(2.29±0.48)mmol/L,(58.49±17.71)mg^2/dl2 vs.(62.90±13.93)mg^2/dl2,P>0.05]。进入维持治疗阶段的患者,维持治疗与初始治疗相比,iPTH水平仍有下降趋势,但差异无统计学意义[(424.82±221.23)pg/mL vs.(517.55±325.77)pg/mL,P>0.05],血钙、血磷以及钙磷乘积比较差异无统计学意义[(2.33±0.20)mmol/L vs.(2.31±0.24)mmol/L,(2.13±0.44)mmol/L vs.(2.00±0.42)mmol/L,(61.24±12.25)mg^2/dl2 vs.(55.76±15.66)mg^2/dl2,P>0.05]。结论帕立骨化醇对非选择性VDRA疗效不佳或不能耐受拟钙剂或不愿手术治疗的维持性血液透析患者SHPT有较好的疗效,明显缓解患者骨痛、瘙痒、疲乏等症状,显著降低iPTH水平,且不增加高钙血症的发生风险。  相似文献   

11.
Objective To study the effcts of total parathyroidectomy with autotransplantation (tPTX+AT) on fibroblast growth factor -23 (FGF - 23) in maintenance hemodialysis (MHD) patients with severe secondary hyperparathyroidism (SPTH). Methods Maintenance hemodialysis patients with severe SPTH treated in our hospital from 2014 to 2016 were enrolled and divided into two groups: tPTX+AT group and non-surgical group. Two groups' biochemical indexes and FGF-23 level before and after 6 months treatment were compared. Results A total of 48 patients were included in the study, including 22 in the tPTX+AT group and 26 in the non-surgical group. Age, duration of dialysis, primary disease, rate of hypertension, parathyroid hormone (iPTH), FGF-23, cholesterol (TCH), triglyceride (TG), albumin (ALB), and hemoglobin (HGB) level showed no significant difference between the two groups (P>0.05); but serum calcium and alkaline phosphatase (ALP) of that tPTX+AT group were significantly higher than those of the non-surgical group (P<0.01). After 6 months the blood iPTH, calcium, phosphorus and the calcium-phosphorus product level of tPTX+AT group were significantly lower than those of non-surgical group (P<0.05). Blood lipids, propagated, HGB, and ALP level had no statistical differences in the two groups (P>0.05); serum FGF-23 progressive declined after 1 week, 1 month, 3 month and 6 month in tPTX+AT patients, and after 6 months, the level of FGF-23 was significantly lower than that of non-surgical patients[1462.9(903.7, 5826.9) ng/L vs 12 627.9(5488.9, 16 844.4) ng/L, P<0.01]. Conclusion tPTX+AT can significantly alleviate calcium and phosphorus metabolism disorders and in 6 months gradually reduce FGF-23 level in patients receiving MHD.  相似文献   

12.
随着透析技术的进步,慢性肾衰竭患者的生存时间逐渐延长,但影响患者生活质量甚至严重威胁患者生命的许多并发症也随之出现.继发性甲状旁腺功能亢进(SHPT)是血液透析患者的常见并发症之一,并且有一定的发病率和病死率,特征性表现主要有:低钙、高磷和高甲状旁腺激素.大多数患者可以通过药物治疗而痊愈,然而,药物治疗并不是都能很好地调节甲状旁腺功能的紊乱,部分患者需要外科干预.本文对慢性肾衰竭血透患者SHPT外科治疗的现状做一综述.
Abstract:
With the development of the dialysis technology,the survival time of patients with chronic renal failure is prolonged,while more complications which affect the quality of life or even threat the life of patients are followed.Secondary hyperparathyroidism(SHPT)with a certain incidence and mortality is one of the common complications,and its main characteristic performances ale hyperphosphatemia,hypocalcemia and high level of parathyroid hormone.Most patients Can be cured by the treatment of medicine while surgical treatment is still required by some cases in which the disorder of the parathyroid function can not be well regulated through medicine treatment.The purpose of this paper is to make a review of the recent studies of surgical treatment in patients with SHPT.  相似文献   

13.
目的观察鲑鱼降钙素治疗维持性血液透析(MHD)患者并发高钙血症的疗效。方法对28例MHD患者合并高钙血症者给予鲑鱼降钙素肌肉注射,开始每天1次,连续6d,以后每周2次,透析后使用。疗程12周。以用药前和用药后第2、4、8、12周检测血钙、血磷、钙磷乘积和血全段甲状旁腺素(iPTH)为指标,应用视觉模拟疼痛评分法对骨关节疼痛程度进行定量,并进行统计学分析。结果25例完成观察。治疗后第4周血钙、钙磷乘积均有不同程度降低,与治疗前比较有统计学意义(P〈0.05);血磷和iPTH也有降低,但与治疗前比较差异无显著性。治疗后第4周,所有患者骨关节疼痛、活动障碍等症状均有不同程度缓解;疗程结束后23例症状基本消失,但治疗前已发生的转移性钙化等现象无变化。结论鲑鱼降钙素治疗MHD患者并发高钙血症,可以有效降低高血钙、钙磷乘积,并能够有效缓解骨关节疼痛症状,近期疗效显著。  相似文献   

14.
目的观察血液透析、血液透析并滤过和血液透析+血液透析并滤过3种血液净化治疗方法对维持性血液透析患者难治性高血压的临床疗效。方法将60例维持性血液透析患者随机分为3组,即血液透析组、血液透析并滤过组和血液透析+血液透析并滤过组各20例。血液透析组每周行血液透析治疗3次;血液透析并滤过组每周行血液透析并滤过治疗3次;血液透析+血液透析并滤过组每周行血液透析治疗2次,血液透析并滤过治疗1次。观察治疗4周和8周后血压的变化。结果血液透析组治疗4周和8周后和治疗前相比,患者血压差异无统计学意义(P〉0.05);血液透析并滤过组和血液透析+血液透析并滤过组中,治疗4周后两组血压都较本组治疗前明显下降(P〈0.05);但两组间比较,差异均无统计学意义(P〉0.05);治疗8周与治疗4周时相比,两组患者血压均基本保持稳定,没有明显进一步下降,差异无统计学意义(P〉0.05)。结论血液透析+血液透析并滤过及血液透析并滤过两种血液净化方式均可以有效改善血液透析患者难治性高血压,而且血液透析+血液透析并滤过比血液透析并滤过方式更为经济。  相似文献   

15.
Objective To investigate cerebrovascular lesions on maintenance hemodialysis (MHD) patients, including types of cerebrovascular disease, and cognitive function changes. Methods A cross-sectional study was applied. A total of 270 MHD patients at hemodialysis center of Peking Union Medical College Hospital were screened, and finally 117 cases were enrolled. Demographic information, aboratory data, MRI and MRA data were collected and assessed. Cognitive function was evaluated with C - MMSE (Chinese mini mental test examination) and C - MoCA (Chinese montreal cognitive assessment). The related factors were selected by Spearman correlation analysis, multiple linear regression and logistic regression analysis. Results The patients’average age was (56.0± 12.5) years, average hemodialysis age was (73.5±60.8) months. Only 5.1% patients had clinical history of cerebral infarction or hemorrhage. Pre - hemodialysis blood pressure was (142.7/80.3±18.2/12.9) mmHg, Post-hemodialysis blood pressure was (130.2/79.1±23.4/14.9) mmHg. A total of 18.8% patients had intra-hemodialysis hypotension, spKt/V was (1.45±0.25). MR results showed that 12.0% patients had cerebral artery stenosis, 5.1% patients had cortical infarcts, 39.3% patients had lacunar infarcts, 47.0% patients had microbleeds, 7.7% patients had chronic hematoma, 52.1% patients had abnormal brain whiter matter lesions (WMLs). In cognitive function evaluation, 20.9% patients had abnormal C-MMSE scores, but 65.2% patients had abnormal C-MoCA results. Multiple linear regression showed age (b=0.059, P<0.01), dialysis age (b=0.005, P<0.05) were associated with WMLs in MHD patients. Intra-hemodialysis hypotension was an independent risk factor of lacunar infarcts (b=2.123, P<0.01) and microbleeds (b=3.531, P<0.01). Low serum albumin level was an independent risk factor of cognitive decline (b=0.314, P<0.05). Logistic regression analysis showed pre - hemodialysis systolic blood pressure was an independent risk factor of cortical infarcts [OR=1.088, 95%CI (1.018-1.152), P< 0.05]. Gender, dialysis age and pre - dialysis serum TCO2 level were related with chronic hematoma. Conclusions WMLs is related with dialysis voltage. Lacunar infarcts and mirobleeds are related with intra - hemodialysis hypotension. Lacunar infarcts, WMLs and nutritional status are contributed to decline of cognition in MHD patients.  相似文献   

16.
Objective To investigate the relationship between serum phosphorus variability and mortality in maintenance hemodialysis (MHD) patients. Methods A total of 502 MHD cases from Renji hospital hemodialysis center were registered in Shanghai Registry Network from January 2007 to April 2015. They were recruited with general information, laboratory results and outcomes. According to their median of coefficient of variation (CV) of blood phosphorus, the patients were divided into high variation group (CV≥0.226 mmol/L) and low variation group (CV<0.226 mmol/L). The relationship of serum phosphorus CV with all-cause mortality and cardiovascular disease mortality was assessed respectively. Results The average age was (63.9±14.6) years, the median dialysis age was 82.0 (43.0, 139.0) months, 118 patients (23.5%) died for all cause and 64 patients (12.7%) died for cardiovascular disease. Compared with patients in low phosphorus variation group, patients had a higher all-cause mortality in high phosphorus variation group (27.7% vs 19.3%, P=0.028). Higher cardiovascular disease mortality was observed in high variation group as well, but this difference was no statistical significant (15.4% vs 10.0%, P=0.082). COX regression analysis showed that >60 years of age (HR=2.762, 95%CI 1.707-4.468, P<0.001), low hemoglobin (HR=0.466, 95%CI 0.317-0.686, P<0.001), low albumin (HR=0.555, 95%CI 0.366-0.840, P=0.005), high CV of phosphorus (HR=1.479, 95%CI 1.023-2.139, P=0.037) were independent risk factors for all-cause mortality. Moreover, >60 years of age (HR=2.666, 95%CI 1.469-4.837, P=0.001), low hemoglobin (HR=0.480, 95%CI 0.238-0.801, P=0.005), and high CV of phosphorus (HR=1.655, 95%CI 1.003-2.729, P=0.049) were independent risk factors for cardiovascular disease mortality. There was no significant statistical difference between patients phosphorus on target and patients phosphorus below target in all-cause disease mortality (P=0.065) and cardiovascular disease mortality (P=0.425). High variation group whose phosphorus on target had higher all-cause mortality and cardiovascular disease mortality than those in low variation group (29.2% vs 16.9%, P=0.047; 15.0% vs 6.0%, P=0.033). Kaplan-Meier method showed that patients with high phosphorus variation had higher all-cause (P=0.023) and cardiovascular disease mortality (P=0.047) than patients with low phosphorus variation. Conclusions The high CV of phosphorus is independently correlated with all-cause and cardiovascular disease mortality. Patients with standard-reaching phosphorus in the low variation group have a lower mortality. A serum phosphorus level sustainably reaching the standard may improve the survival in MHD patients.  相似文献   

17.
Objective With multi-center investigation, to assess the life quality of patients with maintained hemodialysis (MHD) in Liaoning Province and to explore the relationship among the mineral metabolism, the life quality of the patients with MHD, and the repeated hospitalization within the latest three years. Methods 1192 patients with hemodialysis (at least 3 months) from January to March in 2015 at ten blood purification centers in Liaoning Province were selected for the cross - sectional survey. The Kidney Health-related Quality of Life (HRQOL) version 1.3 was used to evaluate the MHD patients' life quality. The total length of hospitalization was divided into four groups: 0 days, 3 to 15 days, 16 to 30 days and above 30 days. Results When serum calcium value ranged from 2.1 to 2.5 mmol/L, kidney - disease component summary (KDCS), mental component summary (MCS), physical component summary (PCS) and SF-36+KDCS corresponded to a higher value (P<0.05). When serum phosphorus value ranged from 1.13 to 1.78 mmol/L, KDCS and SF-36+KDCS corresponded to a higher value (P<0.05). When the calcium phosphorus product value ranged from 40.68 to 49.94, MCS corresponded to a higher value (P<0.05). KDCS showed a linear correlation with age (P<0.001), dialysis age, serum calcium (less than or equal to 2.5 mmol/L) (P<0.05); PCS showed a linear correlation with age (P<0.001) and dialysis age (P<0.05); SF-36+KDCS showed a linear correlation with age (P<0.001), and serum calcium (less than or equal to 2.5 mmol/L) (P<0.05), while age and dialysis age were negatively correlated. The hospitalization days showed a linear correlation with age, dialysis age (P<0.001) and serum phosphorus, calcium phosphorus product value (P<0.05), while dialysis age and calcium phosphorus product value were negatively correlated. Among different groups of total hospitalization days in three years, age, hemodialysis age, serum calcium, serum phosphorus, calcium-phosphorus product value and quality of life values were all statistically significant (P<0.05). Conclusions The life quality of patients with MHD were correlated with serum calcium, phosphorus, calcium and phosphorus product value, iPTH, dialysis age and age, while age and dialysis age were of negative correlation. The total number of hospitalization days in 3 years was closely linearly correlated with age and dialysis age, significantly correlated with serum phosphorus, calcium and phosphorus product value, while dialysis age, calcium and phosphorus product value were in a negative correlation. The total number of hospitalization in 3 years was correlated with the patients' age, dialysis age, serum calcium, serum phosphorus, calcium and phosphorus product value and quality of life.  相似文献   

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