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| 甲状旁腺切除加自体移植术对尿毒症患者近期临床症状及钙磷代谢的影响（附20例临床分析） |
| Effects of parathyroidectomy and autotransplantation on short-term clinical symptoms and calcium phosphorus metabolism in uremic patients |
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| DOI：10.3969/j.issn.1006-7108.2016.10.013 |
| 中文关键词: 尿毒症 甲状旁腺功能亢进 甲状旁腺切除 钙磷代谢 |
| 英文关键词:Uremia hyperparathyroidism Parathyroidectomy Calcium phosphorus metabolism |
| 基金项目:安徽省自然科学基金项目（1308085MH155） |
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| 中文摘要: |
| 目的 观察甲状旁腺切除加自体移植(parathyroidectomy with autotransplantation, PTX+AT)对尿毒症继发性甲状旁腺功能亢进症(secondary hyperparathyroidism ,SHPT)患者近期临床症状及各项生化指标的影响。 方法 回顾性分析20例SHPT手术前和手术后短期内的临床症状、血清全段甲状旁腺激素（intact parathyroid hormone，iPTH）、血钙、血磷等变化以及术后近期疗效及并发症的发生情况。 结果 20例尿毒症继发性甲状旁腺功能亢进症患者，术前iPTH为（1648±797）pg/mL，甲状旁腺切除后，术后1w iPTH为（125±263）pg/mL，P<0.01，差异具有统计学意义。术前血钙（2.58±0.25）mmol/L、血磷（2.30±0.73）mmol/L；术后第1天血钙（1.97±0.46）mmol/L、血磷（1.92±0.81）mmol/L，术后1w血钙（1.99±0.46）mmol/L、血磷（1.38±0.66）mmol/L。术后1w 15例患者（占总失眠人数100%）失眠症状，13例患者（占总皮肤瘙痒人数80%）皮肤瘙痒症状、3例患者（占不安腿人数100%）不安腿症状明显好转，12例患者（占骨关节痛患者80%）骨关节疼痛症状、5例患者（占肌无力患者60%）肌无力症状有所改善。术后5位患者出现抽搐，4例患者出现声音嘶哑，经相应处理后，患者症状明显改善。 结论 甲状旁腺切除在短期内显著改善尿毒症继发性甲状旁腺功能亢进患者的骨关节痛、皮肤瘙痒、肌无力、失眠等临床症状，同时缓解高钙，高磷血症。 |
| 英文摘要: |
| Objective To study the effect of parathyroidectomy with autotransplantation (PTX+AT) on short-term physiological indicators in patients with uremic secondary hyperparathyroidism (SHPT). Methods Retrospective analysis was made on the short-term clinical symptoms of 20 patients with uremic SHPT who underwent PTX+AT, including the changes of their serum calcium (Ca), phosphorus (P) and intact parathyroid hormone (iPTH) before and after the operations, as well as their postoperative curative effect and complications. Result In all 20 uremic SHPT, the mean iPTH was (1648±797) pg/mL before operation and was (125±263) pg/mL on the 7th day after operation, the difference is statistically significant (P<0.01). The mean serum calcium and phosphorus before operation were (2.58±0.25) and (2.30±0.73) mmol/L, respectively. On the first day after the operation, the mean serum calcium and phosphorus were (1.97±0.46) mmol/L and (1.92±0.81) mmol/L, respectively, while the means at a week after were (1.99±0.46) mmol/L and (1.38±0.66）mmol/L, respectively. One week after the operation, 15 patients with insomnia (accounting for 100% of total number of patients with insomnia), 13 cases with itchy skin (accounting for 80% of patients with itchy skin) and 3 patients with symptoms of restless legs symptoms (accounting for 100% of patients with restless legs symptoms) improved markedly. Besides, 12 patients with symptoms of joint pain (accounting for 80% of patients with joint pain）and 5 patients with symptoms of muscle weakness (accounting for 60% of patients with muscle weakness) also improved. Five patients experienced convulsions and four patients suffered hoarseness after the operation. However, after appropriate treatment, the symptoms improved significantly. Conclusion Removal of Parathyroid gland can, in a short time, significantly relieve joint pain, itching, muscle weakness, insomnia and other symptoms of the uremia patients with secondary hyperparathyroidism. It can also alleviate high calcium and hyperphosphatemia. |
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