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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 study the effect of total parathyroidectomy on coronary artery calcification and left ventricular hypertrophy in patients with hyperparathyroidism secondary to uremia. Methods: Thirty-six patients undergoing total parathyroidectomy with secondary hyperparathyroidism were selected in our hospital for maintenance hemodialysis. Serum parathyroid hormone, phosphorus, Calcium and alkaline phosphatase levels and other related indicators, and the use of imaging ultrasound detection of coronary artery calcification score and left ventricular end-diastolic diameter (LVDd), end-diastolic ventricular septal thickness (LVST), end-diastolic left ventricular posterior wall thickness (LVPWT) , Correlation analysis of test indicators. Results: Compared with preoperative, serum calcium level, serum phosphorus level, calcium and phosphorus product, parathyroid hormone level and bone specific alkaline phosphatase were significantly decreased at 6 and 12 months after parathyroidectomy (P <0.01). The changes of coronary artery calcification scores at 6 and 12 months after parathyroidectomy were statistically significant (P <0.01). The values of LVPWT and LVDd at 6 and 12 months after operation Significantly reduced (P <0.05). Conclusion: Parathyroidectomy can effectively control the progression of coronary artery calcification in patients with hyperparathyroidism secondary to uremia, and can effectively improve left ventricular hypertrophy and reduce cardiovascular risk in patients with hyperparathyroidism Disease death risk.