甲状旁腺切除治疗尿毒症继发性甲状旁腺功能亢进症患者皮肤瘙痒的临床观察

目的 观察甲状旁腺切除对尿毒症继发性甲状旁腺功能亢进症（Secondary Hyperparathyroidism,SHPT）患者皮肤瘙痒的治疗效果.方法 选取30例SHPT伴皮肤瘙痒患者,手术切除甲状旁腺,于手术前及手术1个月后分别进行皮肤瘙痒评分,观察皮肤瘙痒改善情况,比较手术前及手术1个月后血清钙、血清磷、钙磷乘积、血清全段甲状旁腺激素（iPTH）、β2-微球蛋白（β2 MG）水平、皮肤瘙痒评分的变化.结果 与手术前比较,甲状旁腺切除1个月后,患者血iPTH、血磷、钙磷乘积、血钙水平均明显下降（tiPTH=-9.790,P=0.000;tp=-10.501,P=0.000;tca×p=-11.140,P=0.000,tca=-6.285,P=0.000）;手术前后β2-MG比较,差异无统计学意义（P＞0.05）；手术后有29例患者皮肤瘙痒症状减轻,治疗有效率达96.7％,皮肤瘙瘁评分由27.2±12.0下降至5.2±8.4（t=-9.584,P=-0.000）.结论 甲状旁腺切除能有效改善尿毒症继发性甲状旁腺功能亢进患者的皮肤瘙痒症状.

A clinical observation of parathyroidectomy on pruritus in uremic patients with secondary hyperparathyroidism

Objective To observe the clinical effect of parathyroidectomy on pruritus in uremic patients with secondary hyperparathyroidism （SHPT）. Methods Thirty uremic patients with SHPT and pruritus were recruited in this study. Their serum calcium, phosphorus, calcium and phosphorus product （Ca×P）, intact para- thyroid hormone （iPTH）, and β2-microglobulin （β2-MG） were measured, and their pruritus scores were record- ed before and after parathyroidectomy for one month. Results Serum iPTH, calcium, phosphorus and Ca × P decreased after parathyroideetomy for one month, as compared with those before the treatment （tiPTH =- 9.790, P= 0.000; tCa = -6.285, P= 0.000; tp = -10.501, P= 0.000; tCa×p = -11.140, P= 0.000）, but serum β 2-MG did not change significantly （P 〉0.05）. Pruritus improved in 29 of 30 cases （96.7%） with the decrease of average pruritus score from 27.2± 12.0 to 5.2 ±8.4 （t =-9.584, P=0.000） after parathyroidectomy for one month. Conclusion Parathvroidectomy is effective on prurutis in uremic patients with SHPT.