【摘要】目的在尿毒症甲状旁腺腺瘤形成行甲状旁腺切除术(parathyroidectomy，PTX)的患者中，探讨异常增高的甲状旁腺激素水平与营养状态之间的关系。方法回顾性分析2015 年9 月～2020 年7 月在青岛大学附属医院行PTX 的患者118 例，分析手术前1 周及手术后半年透析前全段甲状旁腺激素(iPTH)、血钙、血磷、碱性磷酸酶及体质量指数、血白蛋白等营养相关的临床指标，采用主观全面营养评估法(subjective global assessment，SGA) 及Edmonton 衰弱评分量表对患者行营养评估。结果iPTH (Z=-7.940、P＜0.001)、血钙(Z=-9.101、P＜0.001)、血磷(Z=-8.396、P＜0.001)、碱性磷酸酶(Z=-8.367、P＜0.001)、血白蛋白(Z=-7.940、P＜0.001)、前白蛋白(Z=-5.102、P＜0.001)、体质量指数(Z=-7.341、P＜0.001)等指标手术前后存在统计学差异。SGA 评分及Edmonton 评分显示术后营养不良及衰弱状态改善。手术前iPTH 水平与体质量指数(r =-0.272、P=0.003)、血白蛋白(r =-0.630、P＜0.001)、前白蛋白
(r =-0.165、P=0.020)及SGA评分(r =-0.781、P＜0.001)呈负相关，与Edmonton评分(r =0.611、P＜0.001)呈正相关。结论尿毒症继发性甲状旁腺腺瘤甲状旁腺切除的患者手术前后营养状况差异显著，手术后患者iPTH显著降低，营养相关指标显著改善，衰弱状态显著纠正。
【Abstract】Objective To investigate the relationship between abnormally elevated parathyroid hormone level and nutritional status in uremia patients with parathyroid adenoma undergoing parathyroidectomy (PTX). Methods A total of 118 uremia patients with uremia hyperparathyroidism undergoing PTX treated in the Affiliated Hospital of Qingdao University during September 2015 to July 2020 were retrospectively analyzed. Their intact parathyroid hormone (iPTH), serum calcium, phosphate and alkaline phosphatase and the nutrition-related indexes of BMI and serum albumin one week before PTX and after PTX for 6 months were
collected and analyzed. Subjective global assessment (SGA) and Edmonton scoring for debilitating were used for the assessment of nutritional status. Results There were significant differences in serum iPTH (Z=-7.940, P＜0.001), calcium (Z=-9.101, P＜0.001), phosphate (Z=-8.396, P＜0.001), alkaline phosphatase (Z=-8.367, P＜0.001), albumin (Z=-7.940, P＜0.001) prealbumin (Z= -5.102, P＜0.001) and BMI (Z=-7.341, P＜0.001) before and after PTX. The changes of SGA score and Edmonton score indicated the improvement of nutrition and debilitating status after PTX. The preoperative iPTH level was negatively correlated with BMI (r=-0.272, P=0.003), serum albumin (r=-0.630, P＜0.001), prealbumin (r=-0.165, P=0.020) and SGA scores (r=-0.781, P＜0.001), and positively correlated with Edmonton score (r=0.611, P＜0.001). Conclusion The nutritional status was significantly different before and after PTX in uremia patients with hyperparathyroidism. Serum iPTH reduced, and nutrition indexes and debilitating status improved significantly after PTX.
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