南方医科大学学报

南方医科大学学报 ›› 2021, Vol. 41 ›› Issue (6): 947-952.doi: 10.12122/j.issn.1673-4254.2021.06.20

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维持性血液透析患者甲状旁腺切除术后影响移植组织存活的危险因素

龚 薇，谢 宇，林雅琪，孟子璐，王玉栋   

  • 出版日期:2021-06-20 发布日期:2021-07-02

Risk factors affecting graft survival after parathyroidectomy and parathyroid autotransplantation in patients on maintenance hemodialysis

  • Online:2021-06-20 Published:2021-07-02

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摘要： 目的 探讨维持性血液透析（MHD）合并继发性甲状旁腺功能亢进（SHPT）患者接受甲状旁腺切除联合甲状旁腺部分组织移植在自体胸锁乳突肌区（TPTX+AT）后甲状旁腺移植的部位、方式以及甲状旁腺组织存活影响因素。方法 回顾性分析2010年1月~2020年2月在广东药科大学附属第一医院因SHPT接受TPTX+AT的MHD患者的临床资料。收集入选患者的一般临床资料和围手术期iPTH、血磷、血钙、ALP，血红蛋白（Hb）指标结果。根据术后2周双前臂及甲状旁腺素（iPTH）比值>1.5与否分为成活组与未成活组。比较两组患者的一般临床资料和围手术期相关指标的差异，logistics回归分析影响患者术后甲状旁腺移植存活的危险因素。结果 87例患者纳入本研究，术后甲状旁腺移植的存活率为78.16%。甲状旁腺移植存活组与非存活组术后1周、1月、2月、3月、6月、12月的血钙、血磷、iPTH、碱性磷酸酶（ALP）较术前明显下降(P<0.001)；血红蛋白较术前明显升高（P=0.007）。多元线性回归分析ALP是影响甲状旁腺移植存活的独立危险因素[OR=1.003，95%CI（1.001，1.005），P=0.004]。结论 TPTX+AT是治疗SHPT的一种安全有效的方法，术前血ALP较高的患者术后甲状旁腺组织不容易存活。

关键词: 继发性甲状旁腺功能亢进；甲状旁腺切除联合自体胸锁乳突肌移植；甲状旁腺移植

Abstract: Objective To investigate the risk factors affecting the survival of parathyroid autograft following total parathyroidectomy combined with autologous sternocleidomastoid muscle transplantation (TPTX + AT) in patients on maintenance hemodialysis (MHD) complicated with secondary hyperparathyroidism (SHPT). Methods This retrospective study was conducted among the patients on maintenance hemodialysis with SHPT, who underwent successful parathyroidectomy and autotransplantation from January, 2010 to February, 2020 in our hospital. The clinical data and serum levels of calcium, phosphorus, intact parathyroid hormone, hemoglobin, and alkaline phosphatase (ALP) of the patients were collected. The enrolled patients were divided into survival group with bilateral forearm parathyroid hormone (iPTH) ratio >1.5 and death group with a ratio <1.5 at 2 weeks after surgery for comparison of the clinical data and perioperative indicators. The risk factors of postoperative parathyroid autograft survival were analyzed using logistic regression analysis. Results A total of 87 patients were included in the study, among whom the graft survival rate after parathyroid transplantation was 78.16%. In both groups, serum levels of calcium, phosphorus, iPTH and ALP decreased and hemoglobin level increased significantly at 1 week and 1, 2, 3, 6 and 12 months after surgery (P<0.01). Logistic regression analysis showed that serum ALP level was an independent risk factor for graft survival following parathyroid autotransplantation [OR=1.003, 95% CI: 1.001-1.005, P=0.004]. Conclusion TPTX+AT is a safe and effective treatment for SHPT, and parathyroid autografts are less likely to survive following parathyroid transplantation in patients with high preoperative level of ALP.

Key words: hyperparathyroidism, secondary; total parathyroidectomy combined with autologous sternocleidomastoid muscle transplantation; parathyroid transplantation