【摘要】 目的 探讨继发性甲状旁腺功能亢进症(secondary hyperparathyroidism，SHPT)患者甲状旁腺组织病理形态改变与甲状旁腺激素水平、透析龄等因素的关系。方法 通过形态学观察比较，研究48例规律透析患者因SHPT切除的甲状旁腺病理学形态特征。结果 甲状旁腺激素水平与增生甲状旁腺的细胞类型无相关性，与患者性别、继发陈旧性出血及钙化程度无相关性（p＞0.05），48例规律透析患者SHPT（95.8%,46/48）以甲状旁腺结节状增生为主，甲状旁腺继发性出血（70.8%,34/48）及钙化（62.5%,30/48）在SHPT的规律透析患者中广泛存在，透析龄的延长对钙化的程度及范围影响较大（p＜0.05）。电镜下可见增生的甲状旁腺细胞内含丰富的线粒体及核蛋白体。结论 长期规律透析患者形成SHPT时甲状旁腺内钙化灶形成及反复的出血是常见的继发性改变，结节状增生是难治性继发性甲状旁腺增生的病理形态基础。电镜下所见提示增生的甲状旁腺细胞呈高活性状态。

【Abstract】 Objective To study the pathological characteristics in secondary hyperparathyroidism(SHPT) among different clinical factors. Methods Totally 48 patients with end-stage renal disease accepted dialysis and were diagnosed as SHPT in China-Japan friendship hospital during 2009 to 2012. The pathological characteristics of 48 cases were analyzed and compared with different clinical factors through retrospective analysis respectively. The ultrastructure of 8 cases fresh parathyroid in dialysis recipients were examined under electron microscope. Results The expression level of parathyroid had no relation to the cell type of parathyroid 、secondary hemorrhage or calcification and M/F ratio（p＞0.05）. Hemorrhage （70.8%,34/48）and/or calcification （62.5%,30/48）appeared evenly in different level group of patients with secondary hyperparathyroidism. Nodular hyperplasia was the predominant growth pattern （95.8%,46/48）in 48 cases secondary hyperparathyroidism patients who accepted dialysis. The calcification in parathyroid became more extensive as dialysis time prolonged（p＜0.05）. Mitochondria and ribosome in hyperplastic parathyroid cell increased remarkably. Conclusions Parathyroid hemorrhage and/or calcification often appear in dialysis recipients who had SHPT. The extent of calcification in parathyroid correlated with dialysis time. Nodular hyperplasia was the important pathologic basis of refractory SHPT in dialysis recipients with end-stage renal disease. The ultrastructure changes in hyperplastic parathyroid gland indicated high activated state of parathyroid cells.