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目的:观察甲状旁腺切除术(parathyroidectomy,PTX)对尿毒症并继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)患者冠状动脉钙化和心血管事件的影响。方法:将74例临床诊断SHPT明确的尿毒症患者,按照是否同意接受手术的意愿分为手术组和常规治疗组。手术组切除甲状旁腺,常规治疗组按KDOQI指南进行骨化三醇冲击治疗。结果:手术组1年后血清Ca、P、钙磷乘积(Ca×P)、i PTH、冠状动脉钙化积分均明显下降(P<0.05),同常规治疗组比较,差异有统计学意义(P<0.01)。常规治疗组1年后虽然甲状旁腺激素也明显下降,但冠状动脉钙化积分进展性升高,差异有统计学意义(P<0.05)。随访期间,手术组同常规治疗组心血管事件发生率比较,差异有统计学意义(P<0.05)。logistic回归分析显示冠状动脉钙化与血钙、磷、钙磷乘积显著相关,差异有统计学意义(P<0.01),而血磷、冠脉钙化是血液透析患者心血管事件发生的重要危险因素,差异有统计学意义(P<0.01)。结论:甲状旁腺切除术能改善SHPT患者冠状动脉钙化,降低心血管事件发生率。
Objective: To observe the effect of parathyroidectomy (PTX) on coronary artery calcification and cardiovascular events in patients with uremia and secondary hyperparathyroidism (SHPT). Methods: 74 patients with definite diagnosis of uremia with SHPT were divided into operation group and conventional treatment group according to willingness to agree to surgery. Surgical removal of parathyroid gland, conventional treatment group according to KDOQI guidelines calcitriol treatment. Results: After one year, the levels of Ca, P, Ca, P and i PTH and coronary artery calcification scores in the operation group decreased significantly (P <0.05), and the difference was statistically significant (P <0.01). Although the parathyroid hormone was significantly decreased after 1 year in the conventional treatment group, the score of coronary artery calcification increased progressively, the difference was statistically significant (P <0.05). During the follow-up period, there was significant difference in the incidence of cardiovascular events between the operation group and the routine treatment group (P <0.05). Logistic regression analysis showed that there was a significant correlation between the coronary calcification and the product of calcium, phosphorus and calcium phosphorus (P <0.01), while phosphorus and coronary calcium were the important risk factors of cardiovascular events in hemodialysis patients. The difference was statistically significant (P <0.01). Conclusion: Parathyroidectomy can improve coronary artery calcification and reduce the incidence of cardiovascular events in patients with SHPT.