甲状旁腺切除对继发性甲状旁腺功能亢进症患者左心室肥厚的影响

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）患者左心室肥厚的影响。方法选取21例SHPT患者，分为手术组13例和常规治疗组8例，手术组切除甲状旁腺，于手术前及手术1年后分别化验血清钙（ca）、血清磷（P）、血清全段甲状旁腺激素（iPTH），进行心脏超声检查，测量左室舒张末期内径（LVED），室间隔厚度（IVST）、左室后壁厚度（LVP—wT），左心室射血分数（LVEF）计算左心室重量指数（LVMI）。结果手术1年后，手术组患者血清Ca、P、CaXP、iPTH水平均较术前明显降低（t=-3．823、3．873、-4．531、-10．545，均P〈O．01），LVMI由153．7±56．7g／m^2下降到119．5±29．4g／m^2，手术治疗对LVMI、IVST、LVPWT的影响具有统计学意义（F=4．180、4．174、5．959，P=0．048、0．048、0．019），对LVED、LVEF的影响无统计学差异（F=2．662、1．010，P=0．111、0．377）。结论甲状旁腺切除能有效改善尿毒症SHPT患者的左心室肥厚。

Effects of parathyroidectomy on left ventricular hypertrophy in uremic patients with secondary hyperparathyroidism

Objective To observe the effect ofparathyroidcctomy on left ventricular hypertrophy in uremic patients with secondary hyperparathyroidism （SHPT）. Methods Twenty-one SHPT patients were divid- ed into two groups： parathyroidectomy group （n=13） and regular treatment group （n=8）. Before parathyroidectomy and after the operation for one year, serum calcium （Ca）, phosphorus （P）, parathyroid （iPTH）, left ventricular end diastolic diameter （LVED）, interventricular septum diastolic thickness （IVST）, left ventricular posterior wall diastolic thickness （LVPWT）, left ventricular ejection fraction （LVEF） were measured, and LVMI was calculated. Results Serum Ca, P, Ca x p and iPTH decreased after parathyroidectomy （t =- 3.823,- 3.873, -4.531 and -10.545, respectively; P〈0.01）. LVMI decreased from 153.7±56.7 g/m^2 to 119.5±29.4 g/m^2. Parathyroidectomy significantly influenced the values of LVMI, IVST and LVPWT （F=4.180, 4.174 and 5.959, respectively; P=0.048, 0.048 and 0.019, respectively）. Conclusion Parathyroidectomy could improve left ventricular hypertrophy in uremic patients with secondary hyperparathyroidism