甲状旁腺全切术对尿毒症继发甲状旁腺功能亢进症患者冠脉钙化及左心室肥厚的影响-现代医学

甲状旁腺全切术对尿毒症继发甲状旁腺功能亢进症患者冠脉钙化及左心室肥厚的影响

单位：绵阳市中心医院普外科, 四川绵阳 621000

分类号：R692.5;R582.1

出版年·卷·期（页码）：2017·36·第十期（1438-1441）

摘要：

目的：研究甲状旁腺全切术对尿毒症继发甲状旁腺功能亢进症患者冠状动脉钙化及左心室肥厚的影响。方法：选择我院维持性血液透析继发甲状旁腺功能亢进行甲状旁腺全切术的患者36例，实验室检测手术前及手术后6、12个月的血清甲状旁腺激素、磷、钙以及碱性磷酸酶水平等相关指标，并利用影像学超声检测冠状动脉钙化积分及左心室舒张末期内径（LVDd）、舒张末期室间隔厚度（LVST）、舒张末期左心室后壁厚度（LVPWT），对检测指标进行相关性分析。结果：与术前相比，甲状旁腺切除术后6、12个月患者血清钙水平、血清磷水平、钙磷乘积结果、甲状旁腺激素水平、骨特异性碱性磷酸酶变化均显著降低（P<0.01），甲状旁腺切除术后6、12个月的冠状动脉钙化积分变化差异有统计学意义（P<0.01），术后6、12个月LVPWT、LVDd与术前比较数值均明显缩小（P<0.05）。结论：行甲状旁腺切除术能有效控制尿毒症继发甲状旁腺功能亢进症患者冠状动脉钙化的进展，并能有效改善尿毒症甲状旁腺功能亢进症患者的左心室肥厚，降低其心血管疾病死亡风险。

Objective: To analyze the influence of total parathyroidectomy on coronary artery calcification and left ventricular hypertrophy in uremia patients with secondary hyperparathyroidism(SHPT).Methods: Thirty-six cases of hemodialysis patients with SHPT who had undergone total parathyroidectomy were included in the study. The preoperative, postoperative and follow-up serum parathyroid hormone, serum calcium, serum phosphorus, alkaline phosphatase, coronary artery calcium score(CAC), end-diastolic diameters of left ventricular posterior wall thickness(LVPWT), left ventricular end-diastolic dimension(LVEDD) and interventricular septum thickness(IVST) were statistically analyzed. Results: Compared with preoperation, serum calcium, serum phosphorus, the calcium-phosphorus product, parathyroid hormone, bone-specific alkaline phosphatase, and CAC were decreased significantly(P<0.01).6 months and 12 months after operation with statistically significant difference, and LVPWT and LVDD were also decreased significantly(all P<0.05).Conclusion: Total parathyroidectomy can effectively control the progress of coronary artery calcification, improve the left ventricular hypertrophy and reduce the risk of cardiovascular death in uremic patients with secondary hyperparathyroidism(SHPT).

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