目的 探究超声引导下射频消融(radiofrequency ablation,RFA)治疗慢性肾脏病(chronical kidney disease,CKD)继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)的疗效及对喉返神经损伤的影响。 方法 选取2020年9月—2022年2月就诊于河南科技大学第一附属医院血液净化中心的18例CKD并SHPT的患者为研究对象，分别在RFA治疗前、治疗后1d、7d、1月、3月、6月采集患者静脉血，检测全段甲状旁腺激素(intact parathyroid hormone,iPTH)、血磷、血钙、碱性磷酸酶(alkaline phosphatase，ALP)，并记录患者骨痛、皮肤瘙痒、肌力分级与并发症发生情况。 结果 RFA治疗后1d、7d、1月、3月、6月患者钙(F =38.637，P＜0.001)、磷(F =44.175，P＜0.001)、iPTH(F =369.836，P＜0.001)、ALP(F =29.954，P＜0.001)均低于治疗前。治疗后7d内患者血钙水平最低(较治疗前χ2=5.532，P =0.016)，补钙治疗后，血钙水平上升并平稳。治疗后患者骨痛视觉模拟评分(F =9.076，P＜0.001)、皮肤瘙痒症(F =439.309，P＜0.001)明显减轻，肌力分级升高(F =3.755，P＜0.001)。18例患者中6例(33.33%)出现不同程度低钙血症；5例(27.78%)发生喉返神经损伤，3例(16.67%)iPTH再升高，但无临床症状，未出现颈部疼痛情况。 结论 超声引导下RFA治疗CKD继发SHPT疗效显著，可减轻患者骨痛、瘙痒等，改善肌力，安全性较高。
Objective To investigate ultrasound-guided radiofrequency ablation (RFA) in the treatment of secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) patients and its possible injury to recurrent laryngeal nerve. Methods A total of 18 CKD patients with SHPT and admitted to the Blood Purification Center of Department of Nephrology, The First Affiliated Hospital of Henan University of Science and Technology from September 2020 to February 2022 were selected as the research subjects. Venous blood was collected before RFA and after RFA for one day, 7 days, one month, 3 months and 6 months to assay serum intact parathyroid hormone (iPTH), phosphorus, calcium and alkaline phosphatase (ALP). Their bone pain, skin pruritus, muscle strength grade and other complications were recorded. Results After RFA for one day, 7 days, one month, 3 months and 6 months, serum calcium, phosphorus, iPTH and ALP decreased as compared with those before RFA (calcium: F=38.637, P＜0.001; phosphate: F=44.175, P＜0.001; iPTH: F=369.836, P＜0.001; ALP: F=29.954, P＜0.001). Within 7 days after RFA, serum calcium decreased to the lowest (χ2=5.532, P=0.016, compared with those before RFA), and serum calcium increased and stabilized after supplement of calcium to the patients. After RFA, bone pain, blurred vision and pruritus relieved significantly, and muscle strength grade increased (vision: F=9.076, P＜0.001; pruritus: F=439.309, P＜0.001; muscle: F=3.755, P＜0.001). Six of the 18 patients (33.33%) had hypocalcemia of different degrees. Recurrent laryngeal nerve injury occurred in 5 patients (27.78%). Higher serum iPTH recurred but without symptoms and neck pain in 3 patients (16.67%). Conclusion Ultrasound-guided RFA is effective for the treatment of SHPT in CKD patients. It can relieve bone pain, pruritus and improve muscle strength, with higher safety.
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