[1]王佳莹,谭 峰,吴宸极,等.维持性血液透析伴继发性甲状旁腺功能亢进患者甲状旁腺切除术后骨饥饿综合征发生影响因素及血清离子变化特征[J].陕西医学杂志,2021,50(3):334-337.[doi:DOI:10.3969/j.issn.1000-7377.2021.03.020]
点击复制

维持性血液透析伴继发性甲状旁腺功能亢进患者甲状旁腺切除术后骨饥饿综合征发生影响因素及血清离子变化特征
分享到:

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
50
期数:
2021年3期
页码:
334-337
栏目:
临床研究
出版日期:
2021-03-01

文章信息/Info

作者:
王佳莹谭 峰吴宸极张艺凡封 媛
(铜川市人民医院肾脏内科,陕西 铜川 727007)
关键词:
维持性血液透析 继发性甲状旁腺功能亢进 甲状旁腺切除术 骨饥饿综合征 影响因素 血清离子
分类号:
R 681
DOI:
DOI:10.3969/j.issn.1000-7377.2021.03.020
文献标志码:
A
摘要:
目的:探讨维持性血液透析(MHD)伴继发性甲状旁腺功能亢进(SHPT)患者甲状旁腺切除术(PTX)后骨饥饿综合征(HBS)发生的影响因素及血清离子变化特征。方法:回顾性分析行PTX治疗的MHD伴SHPT患者153例临床资料,根据术后有无发生HBS分组,记录临床特征资料。采用Logistic回归模型分析PTX术后HBS发生的独立影响因素。采用多元线性回归模型评价静脉补钙总时间、静脉补钙总量及术后24 h内血清钾离子峰值的独立影响因素。结果:MHD伴SHPT患者PTX术后HBS发生与术前血清钙离子系数、术前血清全段甲状旁腺激素(iPTH)及术前血清碱性磷酸酶(ALP)水平均有关(均P<0.05)。术前血清钙离子系数和血清ALP水平是MHD伴SHPT患者PTX术后HBS发生的独立影响因素(均P<0.05)。PTX术后出现HBS患者静脉补钙总时间与年龄、术前血清钙离子、术前血清白蛋白(ALB)、术前血红蛋白(Hb)、术前血清iPTH及术前血清ALP水平均具有相关性(均P<0.05),而静脉补钙总量与年龄、术前血清钙离子、术前血清磷离子、术前ALB、术前Hb、术前血清iPTH及术前血清ALP水平均具有相关性(均P<0.05)。术前血清iPTH、血清ALP及Hb水平是PTX术后出现HBS患者静脉补钙总时间及总量的独立影响因素(均P<0.05)。患者术后24 h内血清钾离子峰值水平与术前血清磷离子和术前血清钾离子水平均具有相关性(均P<0.05)。患者术前血清钾离子水平与术前血清iPTH水平具有相关性(P<0.05)。术前血清钾离子水平是MHD伴SHPT患者PTX术后24 h内血清钾离子峰值水平的独立影响因素(P<0.05)。结论:MHD伴SHPT患者PTX术后HBS发生与术前血钙和血ALP水平关系密切,术前血钙水平低、血ALP水平高者更易发生HBS。对于出现HBS患者,如术前血iPTH和(或)ALP水平较高,或术前Hb水平较低,应注意术后增加钙摄入。术前高血钾水平是PTX术后高钾血症发生的独立危险因素。

参考文献/References:

[1] Stefanova D,Ullmann TM,Limberg J,et al.Risk factors for prolonged length of stay and readmission after parathyroidectomy for renal secondary hyperparathyroidism[J].World J Surg,2020,31(7):810-816.
[2] 陈 昕,张 莹.血液透析联合血液灌流对尿毒症患者毒素清除率、炎性因子、钙磷代谢及免疫功能的影响[J].陕西医学杂志,2019,48(6):770-773.
[3] Yang G,Ge Y,Zha X,et al.Peritoneal dialysis can alleviate the clinical course of hungry bone syndrome after parathyroidectomy in dialysis patients with secondary hyperparathyroidism [J].Int Urol Nephrol,2019,51(3):535-542.
[4] Ho LY,Wong PN,Sin HK,et al.Risk factors and clinical course of hungry bone syndrome after total parathyroidectomy in dialysis patients with secondary hyperparathyroidism[J].BMC Nephrol,2017,18(1):12-19.
[5] Wong J,Fu WH,Lim ELA,et al.Hungry bone syndrome after parathyroidectomy in end-stage renal disease patients:Review of an alkaline phosphatase-based treatment protocol[J].Int Urol Nephrol,2020,52(3):557-564.
[6] Koshkelashvili N,Lai JY.Images in clinical medicine.Hyperkalemia after missed hemodialysis[J].N Engl J Med,2016,374(23):2268.
[7] Rodríguez-Ortiz ME,Pendón-Ruiz MMV,Rodríguez M.Parathyroidectomy in dialysis patients:Indications,methods,and consequences[J].Semin Dial,2019,32(5):444-451.
[8] Yang G,Zha X,Mao H,et al.Hypocalcemia-based prediction of hungry bone syndrome after parathyroidectomy in hemodialysis patients with refractory secondary hyperparathyroidism [J].J Int Med Res,2018,46(12):4985-4994.
[9] Fülöp T,Koch CA,Farah MAR,et al.Targeted surgical parathyroidectomy in end-stage renal disease patients and long-term metabolic control:A single-center experience in the current era[J].Hemodial Int,2018,22(3):394-404.
[10] Hernandes FR,Canziani ME,Barreto FC,et al.The shift from high to low turnover bone disease after parathyroidectomy is associated with the progression of vascular calcification in hemodialysis patients:A 12-month follow-up study[J].PLoS One,2017,12(4):e0174811.
[11] Hassanein M,Laird-Fick H,Tikaria R,et al.Removing the problem:Parathyroidectomy for calciphylaxis[J].BMJ Case Rep,2018,11(1):e226696.
[12] Ribeiro MCCB,Vogt BP,Vannini FCD,et al.Role of parathyroid hormone in anorexia on maintenance hemodialysis patients[J].Clin Nutr ESPEN,2019,34:137-141.
[13] Lau WL,Obi Y,Kalantar-Zadeh K.Parathyroidectomy in the management of secondary hyperparathyroidism[J].Clin J Am Soc Nephrol,2018,13(6):952-961.
[14] Afshan S,Farah MAR,Echols V,et al.Persisting hypocalcemia after surgical parathyroidectomy:The differential effectiveness of calcium citrate versus calcium carbonate with acid suppression[J].Am J Med Sci,2017,353(1):82-86.
[15] Li S,Liu S,Chen Q,et al.Clinical predictor of postoperative hyperkalemia after parathyroidectomy in patients with hemodialysis[J].Int J Surg,2018,53:1-4.

相似文献/References:

[1]朱昭章,卢 岚,周凡力△.中青年维持性血液透析患者轻度认知功能损害与透析间低血压相关性研究*[J].陕西医学杂志,2020,49(3):300.
 ZHU Zhaozhang,Lu Lan,ZHOU Fanli..Clinical study on the relationship between mild cognitive impairment and intradialytic hypotension in young and middle-aged maintenance hemodialysis patients[J].,2020,49(3):300.
[2]张 媛,朱小静.维持性血液透析患者骨硬化蛋白、Klotho蛋白水平变化及与冠状动脉钙化相关性分析[J].陕西医学杂志,2021,50(10):1246.[doi:DOI:10.3969/j.issn.1000-7377.2021.10.017]
 ZHANG Yuan,ZHU Xiaojing.Changes of bone sclerostin and Klotho protein levels in maintenance hemodialysis patients and their correlation with coronary artery calcification[J].,2021,50(3):1246.[doi:DOI:10.3969/j.issn.1000-7377.2021.10.017]
[3]姚向飞,刘 华,蔡 东,等.铁蛋白、钙、磷、甲状旁腺激素水平与维持性血液透析患者预后关系研究[J].陕西医学杂志,2023,52(3):297.[doi:DOI:10.3969/j.issn.1000-7377.2023.03.011]
 YAO Xiangfei,LIU Hua,CAI Dong,et al.Relationship between ferritin,calcium,phosphorus,parathyroid hormone levels and prognosis of patients with maintenance hemodialysis[J].,2023,52(3):297.[doi:DOI:10.3969/j.issn.1000-7377.2023.03.011]
[4]邱 瑛,杨玉洁,袁怀红.维持性血液透析患者皮肤瘙痒临床研究进展[J].陕西医学杂志,2023,52(6):775.[doi:DOI:10.3969/j.issn.1000-7377.2023.06.031]
 QIU Ying,YANG Yujie,YUAN Huaihong.Clinical research progress of pruritus in patients undergoing maintenance hemodialysis[J].,2023,52(3):775.[doi:DOI:10.3969/j.issn.1000-7377.2023.06.031]
[5]程 莉,章晓良,吴福杉,等.血清正五聚蛋白3、三叶因子3水平对维持性血液透析患者预后转归的预测价值[J].陕西医学杂志,2023,52(7):814.[doi:DOI:10.3969/j.issn.1000-7377.2023.07.008]
 CHENG Li,ZHANG Xiaoliang,WU Fushan,et al.Predictive value of serum PTX3 and TFF3 levels for prognosis of patients with maintenance hemodialysis[J].,2023,52(3):814.[doi:DOI:10.3969/j.issn.1000-7377.2023.07.008]
[6]章 玉,莫立稳,张青云,等.维持性血液透析患者钙磷代谢紊乱\与营养-炎症状态相关性分析[J].陕西医学杂志,2024,(9):1197.[doi:DOI:10.3969/j.issn.1000-7377.2024.09.009]
 ZHANG Yu,MO Liwen,ZHANG Qingyun,et al.Correlation analysis of calcium-phosphorus metabolism disorder with nutritional-inflammatory status in patients with maintenance hemodialysis[J].,2024,(3):1197.[doi:DOI:10.3969/j.issn.1000-7377.2024.09.009]
[7]吕 宁,杨立娟,尹林林,等.血清可溶性CD40配体、腱糖蛋白C、甲壳质酶蛋白-40联合检测对维持性血液透析并发心血管事件的预测作用[J].陕西医学杂志,2025,54(1):123.[doi:DOI:10.3969/j.issn.1000-7377.2025.01.025]
 LV Ning,YANG Lijuan,YIN Linlin,et al.Effect of serum sCD40L,TN-C and YKL-40 combined detection on cardiovascular events during maintenance hemodialysis[J].,2025,54(3):123.[doi:DOI:10.3969/j.issn.1000-7377.2025.01.025]

更新日期/Last Update: 2021-03-04