【摘要】 目的 探讨Klotho蛋白在慢性肾衰竭继发性甲状旁腺功能亢进（SHPT）甲状旁腺细胞不同增生类型中表达的意义。方法 选取在我院肾内科住院行甲状旁腺全切术的SHPT患者50例为SHPT组，尸体甲状旁腺组织供体8例为健康对照组，收集其血清及甲状旁腺组织标本，SHPT组甲状旁腺组织按病理表现分为结节性增生组和弥漫性增生组，检测血成纤维细胞生长因子-23（FGF-23）及甲状旁腺激素（PTH）水平，免疫组化检测甲状旁腺组织中Klotho蛋白及增殖指标Ki67的表达，计算阳性细胞率。结果 （1）SHPT患者血FGF-23[(1316.80±375.15)pg/ml]与PTH[(2106.00±806.78)pg/ml]呈正相关（r=0.438，P=0.001）。（2）SHPT患者血FGF-23与甲状旁腺组织中Klotho的表达呈负相关（r=-0.379，P=0.007），血PTH与Klotho蛋白呈负相关（r=-0.361，P=0.01）。（3）SHPT组甲状旁腺细胞中Ki67的表达显著高于对照组（F=54.417，P=0.000），Klotho蛋白的表达显著低于对照组（F=49.243，P=0.000）；SHPT组结节性增生甲状旁腺组织中Ki67的表达显著高于弥漫性增生组（t=3.760，P=0.001），Klotho蛋白的表达显著低于弥漫性增生组（t=6.039，P=0.000）。结论 结节性增生甲状旁腺组织中Klotho蛋白表达低于弥漫性增生组织可能是导致SHPT患者甲状旁腺呈不同增生方式的重要原因。

【Abstract】Objective To investigate the difference expression of Klotho in parathyroid cells with nodular hyperplasia and diffuse hyperplasia from Secondary Hyperparathyroidism(SHPT) patients. Method A total of 50 SHPT patients and 8 cadaver were selected were selected and accepted parathyroidectomy. SHPT patients were divided into diffusible hyperplasia group and nodular hyperplasia group according to pathology. Serum fibroblast growth factor-23(FGF-23) and parathyroid hormone(PTH) were detected. The expression of Klotho and Ki67 in different hyperplasia parathyroid cells were detected by immunohistochemistry. Results (1)In SHPT patients, serum FGF-23 was positively correlated with PTH（r=0.438，P=0.001）; (2)Serum FGF-23 was negatively correlated with the expression of Klotho in parathyroid cells（r=-0.379，P=0.007）; serum PTH was negatively correlated with the expression of Klotho in parathyroid cells（r=-0.361，P=0.01）; (3) Compared with control group, the expression of Ki67 in SHPT group was increased significantly（F=54.417，P=0.000）, and the expression of Klotho decreased significantly（F=49.243，P=0.000）. Compared with diffusible hyperplasia group, the expression of Ki67 in nodular hyperplasia increased significantly（t=3.760，P=0.001）, the expression of Klotho decreased significantly（t=6.039，P=0.000）. Conclusion Klotho may contributed to different hyperplasia of parathyroid cells in SHPT patients