【摘要】目的探讨甲状旁腺全切加自体移植术(total parathyroidectomy with auto-transplantation，PTX+AT)是否可改善维持性血液透析继发性甲状旁腺功能亢进(secondary hyperparathyroidism，SHPT)患者临床症状和生活质量。方法纳入来自安徽医科大学第二附属医院肾脏内科明确诊断为SHPT 并行PTX+AT 术的维持性血液透析患者80 例，应用甲状旁腺切除术症状评估(parathyroidectomy
assessment of symptoms，PAS)量表和肾脏病与生活质量问卷36(kidney disease quality of life-36，KDQOL-36)，在术前和术后1 年进行临床症状和生活质量评估，比较手术前后临床症状和生活质量评分的改善情况。结果与手术前比较，术后1 年患者血钙、血磷、钙磷乘积、血清全段甲状旁腺激素水平均明显下降(t 值分别为6.732、10.454、12.962、24.941，P 值分别为0.003、0.004、＜0.001、＜0.001)；PAS 总分下降[(618.130±196.371)比(336.501±91.332)，t=11.791，P=0.001]、生活质量总分提高[(51.760 ± 13.671)比(78.252±9.901)，t=18.831，P＜0.001]。结论PTX+AT 术可显著改善难治性继发性甲状旁腺功能亢进的维持性血液透析患者的临床症状，提高生活质量。
【Abstract】Objective This study aimed to evaluate whether the total parathyroidectomy with auto-transplantation can improve clinical symptoms and quality of life in maintenance hemodialysis (MHD) patients with refractory secondary hyperparathyroidism (SHPT). Methods A total of 80 patients with refractory SHPT experienced total parathyroidectomy with auto-transplantation (PTX+AT) were recruited in this study. Parathyroidectomy assessment of symptoms (PAS) scores and KDQOL-36 questionnaire were used to assess clinical symptoms and quality of life before the surgery and after the surgery for 12 months. Results After
PTX +AT surgery for one year, serum calcium (t=6.732, P=0.003), phosphate (t=10.454, P=0.004), Ca × P (t=12.962, P＜0.001), intact parathyroid hormone (t=24.941, P＜0.001) decreased, as compared with those before PTX + AT surgery. The PAS total score decreased (618.130 ± 196.371 to 336.501 ± 91.332, t=11.791, P=0.001) and the total score of quality of life increased (51.760±13.671 to 78.252±9.901, t=18.831,P＜0.001). Conclusion PTX+AT can effectively improve clinical symptoms and quality of life in MHD patients with refractory SHPT.
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