尿毒症患者心率震荡的变化与甲状旁腺素关系的探讨

目的：探讨尿毒症患者心率震荡（HRT）的变化与甲状旁腺素（PTH）的关系。方法：选择尿毒症血液透析患者82例，检测血肌酐、血清全段PTH（iPTH）等指标，24 h动态心电图收集HRT数据，根据iPTH进行分组：A组（iPTH＞300 ng/L），B组（iPTH≤300 ng/L）；A组给予血液透析、降磷及骨化三醇治疗，治疗后复查上述指标，并进行对比分析；B组给予常规血液透析治疗。结果：与B组相比，A组患者震荡初始值（TO）明显升高，震荡斜率（TS）明显降低，差异有统计学意义（P＜0.05）；A组治疗前后比较，TO明显升高，TS降低，差异有统计学意义（P＜0.05）；血iPTH水平与TO呈正相关（r=0.435，P＜0.05），与TS呈负相关（r=-0.238，P＜0.05）。结论：尿毒症血液透析患者HRT现象明显受损，继发性甲状旁腺功能亢进症（SHPT）与HRT关系密切，治疗SHPT有助于改善HRT。

Relationship between heart rate turbulence changes and parathyroid hormone in uremic patients

Objective: To discuss the relationship between heart rate turbulence (HRT) changes and parathyroid hormone in uremic patients. Methods: Eighty-two MHD patients were divided into group A (iPTH>300 ng/L) and group B (iPTH≤300 ng/L) according parathyroid hormone levels. The patients of group A were given treatment of hemodialysis, blood phosphorus reduction and calcitriol, group B were only given treatment of hemodialysis. All patients underwent 24 h ambulatory electrocardiogram, the turbulence onset (TO) and turbulence slope (TS) were calculated. Blood creatinine, parathyroid hormone were observed before and after treatment. Results: Compared with group B, TO was increased (P<0.05), but TS decreased significantly in group A (P<0.05). Parathyroid hormone levels were positively correlated with TO (r=0.435, P<0.05), and were negatively correlated with TS (r=-0.238, P<0.05). Conclusion: Heart rate turbulence is significantly impaired in uremic patients. Secondary hyperparathyroidism (SHPT) is closely related to HRT. Treatment of SHPT is helpful to HRT.