中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2015年
1期
13-18
,共6页
马丽洁%赵素梅%刘婧%李艳春%李忠心
馬麗潔%趙素梅%劉婧%李豔春%李忠心
마려길%조소매%류청%리염춘%리충심
骨密度%甲状旁腺切除术%甲状旁腺功能亢进症,继发性%血液透析%骨代谢
骨密度%甲狀徬腺切除術%甲狀徬腺功能亢進癥,繼髮性%血液透析%骨代謝
골밀도%갑상방선절제술%갑상방선공능항진증,계발성%혈액투석%골대사
Bone mineral density%Parathyroidectomy%Hyperparathyroidism,secondary%Hemodialysis%Bone metabolism
目的 观察甲状旁腺切除术(parathyroidectomy,PTX)对继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)的维持性血液透析患者骨代谢及骨密度(BMD)的影响.方法 26例SHPT患者行PTX.术前及术后1、3、6、12、18、24个月时常规检测血钙、血磷、血清碱性磷酸酶,化学发光法检测血清全段甲状旁腺素(intact parathyroid,iPTH)、骨钙素(OC)、Ⅰ型前胶原氨基末端前肽(PINP)、β胶原蛋白(β-C TX),术前及术后24个月时双能X线法测定腰椎、股骨颈、骨盆各部位骨密度,观察患者甲状旁腺切除术前、术后骨代谢指标及骨密度变化.结果 (1)与术前比较,血清OC水平[(104.49±25.42) μg/L比(695.46±355.62) μg/L,P＜ 0.01]、PINP水平[(248.36±159.38) μg/L比(809.28±283.50) μg/L,P＜0.01]于手术3个月后明显降低,β-CTX水平于手术1个月后明显降低[(1.60±0.64) μg/L比(3.37±1.34) μg/L,P＜0.01].(2)与术前比较,术后24个月时腰椎BMD[(0.88±0.23) g/cm2比(0.78±0.23) g/cm2,P＜0.01]、股骨颈BMD[(0.96±0.19) g/cm2比(0.84±0.24) g/cm2,P＜ 0.01]及腰椎Z评分[(-1.24±0.55)比(-1.66±0.24),P＜0.01]、股骨颈Z评分[(-1.51±0.72)比(-1.93±0.40),P＜0.01]均升高.(3)相关分析显示,术前血清iPTH水平与⊿腰椎Z评分(r=0.584,P=0.002)、⊿股骨颈Z评分(r=0.400,P=0.043)呈正相关,术前血清OC水平与⊿腰椎Z评分(r=0.651,P＜0.001)、⊿股骨颈Z评分(r=0.509,P=0.008)呈正相关.结论 PTX术可以降低患者升高的iPTH、OC、PINP及β-CTX水平,增加骨密度,同时改善多项生化指标,提高患者生活质量.
目的 觀察甲狀徬腺切除術(parathyroidectomy,PTX)對繼髮性甲狀徬腺功能亢進(secondary hyperparathyroidism,SHPT)的維持性血液透析患者骨代謝及骨密度(BMD)的影響.方法 26例SHPT患者行PTX.術前及術後1、3、6、12、18、24箇月時常規檢測血鈣、血燐、血清堿性燐痠酶,化學髮光法檢測血清全段甲狀徬腺素(intact parathyroid,iPTH)、骨鈣素(OC)、Ⅰ型前膠原氨基末耑前肽(PINP)、β膠原蛋白(β-C TX),術前及術後24箇月時雙能X線法測定腰椎、股骨頸、骨盆各部位骨密度,觀察患者甲狀徬腺切除術前、術後骨代謝指標及骨密度變化.結果 (1)與術前比較,血清OC水平[(104.49±25.42) μg/L比(695.46±355.62) μg/L,P＜ 0.01]、PINP水平[(248.36±159.38) μg/L比(809.28±283.50) μg/L,P＜0.01]于手術3箇月後明顯降低,β-CTX水平于手術1箇月後明顯降低[(1.60±0.64) μg/L比(3.37±1.34) μg/L,P＜0.01].(2)與術前比較,術後24箇月時腰椎BMD[(0.88±0.23) g/cm2比(0.78±0.23) g/cm2,P＜0.01]、股骨頸BMD[(0.96±0.19) g/cm2比(0.84±0.24) g/cm2,P＜ 0.01]及腰椎Z評分[(-1.24±0.55)比(-1.66±0.24),P＜0.01]、股骨頸Z評分[(-1.51±0.72)比(-1.93±0.40),P＜0.01]均升高.(3)相關分析顯示,術前血清iPTH水平與⊿腰椎Z評分(r=0.584,P=0.002)、⊿股骨頸Z評分(r=0.400,P=0.043)呈正相關,術前血清OC水平與⊿腰椎Z評分(r=0.651,P＜0.001)、⊿股骨頸Z評分(r=0.509,P=0.008)呈正相關.結論 PTX術可以降低患者升高的iPTH、OC、PINP及β-CTX水平,增加骨密度,同時改善多項生化指標,提高患者生活質量.
목적 관찰갑상방선절제술(parathyroidectomy,PTX)대계발성갑상방선공능항진(secondary hyperparathyroidism,SHPT)적유지성혈액투석환자골대사급골밀도(BMD)적영향.방법 26례SHPT환자행PTX.술전급술후1、3、6、12、18、24개월시상규검측혈개、혈린、혈청감성린산매,화학발광법검측혈청전단갑상방선소(intact parathyroid,iPTH)、골개소(OC)、Ⅰ형전효원안기말단전태(PINP)、β효원단백(β-C TX),술전급술후24개월시쌍능X선법측정요추、고골경、골분각부위골밀도,관찰환자갑상방선절제술전、술후골대사지표급골밀도변화.결과 (1)여술전비교,혈청OC수평[(104.49±25.42) μg/L비(695.46±355.62) μg/L,P＜ 0.01]、PINP수평[(248.36±159.38) μg/L비(809.28±283.50) μg/L,P＜0.01]우수술3개월후명현강저,β-CTX수평우수술1개월후명현강저[(1.60±0.64) μg/L비(3.37±1.34) μg/L,P＜0.01].(2)여술전비교,술후24개월시요추BMD[(0.88±0.23) g/cm2비(0.78±0.23) g/cm2,P＜0.01]、고골경BMD[(0.96±0.19) g/cm2비(0.84±0.24) g/cm2,P＜ 0.01]급요추Z평분[(-1.24±0.55)비(-1.66±0.24),P＜0.01]、고골경Z평분[(-1.51±0.72)비(-1.93±0.40),P＜0.01]균승고.(3)상관분석현시,술전혈청iPTH수평여⊿요추Z평분(r=0.584,P=0.002)、⊿고골경Z평분(r=0.400,P=0.043)정정상관,술전혈청OC수평여⊿요추Z평분(r=0.651,P＜0.001)、⊿고골경Z평분(r=0.509,P=0.008)정정상관.결론 PTX술가이강저환자승고적iPTH、OC、PINP급β-CTX수평,증가골밀도,동시개선다항생화지표,제고환자생활질량.
Objective To observe the effects of parathyroidectomy(PTX) on bone metabolism and bone mineral density(BMD) in maintenance hemodialysis patients with secondary hyperparathyroidism (SHPT).Methods A total of 26 dialysis patients with SHPT were treated with PTX.Serum calcium,phosphorus,alkaline phosphatase(ALP) levels were determined by standard methods.The levels of serum intact parathyroid (iPTH),osteocalcin (OC),procollagen type Ⅰ aminoterminal propeptide (PINP),β-crosslaps (β-CTX) were measured by chemiluminescence.BMD was measured by dual energy X ray absorptiometry.iPTH,OC,PINP,β-CTX,serum calcium,phosphorus,ALP were measured before parathyroidectomy and 1,3,6,12,18,24 months after operation.Lumbar spine (LS) and femoral neck (FN) BMD were measured before and 24 months after PTX.Results Compared with that before operation,serum OC[(104.49±25.42) μg/L vs (695.46±355.62) μg/L,P ＜ 0.01] and PINP levels [(248.36 ± 159.38) μg/L vs (809.28 ± 283.50) μg/L,P＜ 0.01] progressively decreased 3 months after PTX,and serum β-CTX levels [(1.60±0.64) μg/L vs (3.37±1.34) μg/L,P ＜ 0.01] decreased 1 month after PTX.Compared with that before operation,BMD levels increased 24months after PTX in LS[(0.88±0.23) g/cm2 vs (0.78±0.23) g/cm2,P ＜ 0.01] andFN[(0.96±0.19) g/cm2 vs (0.84±0.24) g/cm2,P ＜ 0.01],and Z-scores were also increased in both LS[(-1.24±0.55) vs (-1.66± 0.24),P ＜ 0.01] and FN[(-1.51 ±0.72) vs (-1.93 ± 0.40),P ＜ 0.01].Correlation analysis showed that baseline iPTH was positively correlated with ⊿Z-score in FN (r=0.584,P=0.002) and LS (r=0.400,P=0.043),and so did the OC with ⊿Z-score in FN (r=0.651,P ＜ 0.001) and LS (r=0.509,P=0.008).Conclusion The levels of OC,PINP and β-CTX are reduced and BMD is improved in hemodialysis patients with SHPT after PTX.
