维持性血液透析患者甲状旁腺切除前后血钙磷变化的相关分析

探讨维持性血液透析患者行甲状旁腺切除术前、后血钙、磷的变化及相关因素. 方法 维持性血液透析行甲状旁腺全切除术（total parathyroidectomy,TPTX）的患者30例,测定手术前及术后第1、4、7日血清全段甲状旁腺激素（intact parathyroid hormone,iPTH）、血碱性磷酸酶（alkaline phosphatase,ALP）、血钙（Calcium,Ca）、血磷（Phosphorus,P）,计算行TPTX后10日内补充元素钙总量,并于术中测量16例患者术中切除甲状旁腺（后经病理证实）的体积. 结果 术前血iPTH、ALP与术后10日内补钙量（r=0.614,P＜0.001、r=0.385,P=0.036）及术中切除甲状旁腺体积（r=0.527,P=0.036、r=0.799,P＜0.001）呈正相关,术前血iPTH、ALP与术后各时间点测得血钙变化均呈负相关（P＜0.05）.术后血磷、血钙进行性下降,于术后第7日较前有明显降低,差异均有统计学意义（P＜0.05）. 结论 术后血磷、血钙进行性下降,术前血iPTH、ALP与术后血钙呈负相关,与术后补充元素钙剂量呈正相关.

The correlation analysis of serum calcium and phosphorus before and after total parathyroidectomy in maintenance hemodialysis patients

Objective To explore the changes and related factors of serum calcium and phosphorus levels after total parathyroidectomy(TPTX) in maintenance hemodialysis(MHD) patients.Methods A total of 30 MHD cases treated with TPTX were included in this study.Their total dosage of element calcium supplement within 10 days,serum intact parathyroid hormone(iPTH),serum alkaline phosphatase(ALP),serum calcium and phosphorus were measured before TPTX and after TPTX for 1st 4th and 7th days.Additionally,the volume of resected parathyroid was measured in 16 cases.Results The preoperative serum iPTH and ALP correlated positively with total dose of element calcium supplemented within 10 days after the operation(r=0.614,P< 0.001 and r=0.385,P=0.036,respectively) and resected parathyroid volume(confirmed by pathological examination)(r=0.527,P=0.036 and r=0.799,P< 0.001,respectively),and correlated negatively with post-operative serum calcium measured at every time point.After TPTX,serum calcium and phosphorus decreased gradually,and significantly decreased at 7th day(P <0.05).Conclusion After TPTX,serum calcium and phosphorus decreased gradually.The pre-operative serum iPTH and ALP correlated negatively to post-operative serum calcium,and positively to the total dose of element calcium supplemented after TPTX.