长期慢性肾衰患者继发性甲状旁腺功能亢进症诊治体会
Diagnosis and Treatment of Secondary Hy-perparathyroidism in Patients with Long-Term Chronic Renal Failure
DOI: 10.12677/HJS.2017.63005, PDF, HTML, XML, 下载: 1,656  浏览: 3,663 
作者: 朱明文, 张宗明*, 林方才, 张翀, 邓海, 于宏伟, 刘卓, 刘立民, 万柏江, 刘子旭, 杨海燕, 廖家红, 骆旭, 温雪, 魏文平, 宋蒙蒙, 赵月:首都医科大学北京电力医院普外科,北京;缪洁萍:首都医科大学北京电力医院肾内科,北京;王培:首都医科大学北京电力医院核医学科,北京;姜楠, 张子超, 张振亚, 潘丽洁, 郭金星:清华大学临床医学院第一附属医院普外科,北京
关键词: 继发性甲状旁腺功能亢进症慢性肾功能衰竭甲状旁腺激素甲状旁腺切除术自体甲状旁腺移植术Secondary Hyperparathyroidism (SHPT) Chronic Renal Failure (CRF) Parathyroid Hormone (PTH) Parathyroidectomy (PTX) Parathyroid Gland Autotransplantation
摘要: 继发性甲状旁腺功能亢进症(secondary hyperparathyroidism, SHPT)是慢性肾衰长期血液透析患者的常见并发症,对于通过低磷饮食、磷结合剂、补充钙剂和维生素D等内科保守治疗无效的难治性SHPT,甲状旁腺切除术日益受到重视,但其手术指征尚缺乏可靠的循证医学证据。本文结合我们对一例18年无尿的61岁SHPT患者的诊治体会,深入探讨SHPT的发生机制、临床表现、辅助检查、治疗原则,以期进一步提高其治疗效果。
Abstract: Secondary hyperparathyroidism (SHPT) is a common complication in hemodialysis patients with chronic renal failure. For patients with refractory SHPT, who have no response to therapies such as low phosphorus diet, phosphorus binders, calcium supplements and vitamin D, parathyroidectomy has received increasing attention. However, evidence-based medicine shows that there is still con-troversy regarding surgical methods, efficacy and safety. Based on our experience in the diagnosis and treatment of a 61-year-old female with SHPT and chronic renal failure manifested as no urine for 18 years, we further explored the pathogenesis, clinical manifestations, supplementary exami-nation, and treatment of SHPT in order to further improve the treatment of this disorder.
文章引用:朱明文, 张宗明, 林方才, 缪洁萍, 王培, 张翀, 邓海, 于宏伟, 刘卓, 刘立民, 万柏江, 刘子旭, 杨海燕, 廖家红, 骆旭, 温雪, 魏文平, 宋蒙蒙, 赵月, 姜楠, 张子超, 张振亚, 潘丽洁, 郭金星. 长期慢性肾衰患者继发性甲状旁腺功能亢进症诊治体会[J]. 外科, 2017, 6(3): 31-36. https://doi.org/10.12677/HJS.2017.63005

参考文献

[1] 曾林文, 吴鸣, 宗兵, 等. 尿毒症继发性甲状旁腺功能亢进症手术治疗的现状[J]. 中国现代普通外科进展, 2015, 18(11): 922-924.
[2] 马进, 耿小平, 陈江明, 等. 甲状旁腺全切除加前臂皮下移植术治疗艮性肾衰继发性甲状旁腺功能亢进症[J]. 中华普通外科杂志, 2016, 31(4): 333-337.
[3] Van der Plas, W.Y., Engelsman, A.F., Özyilmaz, A., et al. (2017) Impact of the Introduction of Calcimimetics on Timing of Parathyroidectomy in Secondary and Tertiary Hyperparathyroidism. Annals of Surgical Oncology, 24, 15-22.
[4] Tentori, F., Wang, M., Bieber, B.A., et al. (2015) Recent Changes in Therapeutic Approaches and Association with Outcomes among Patients with Secondary Hyperpara-thyroidism on Chronic Hemodialysis: The DOPPS Study. Clinical Journal of the American Society of Nephrology, 10, 98-109.
[5] 任捷艺, 康杰, 伍波, 邓先兆, 丁政, 艾开兴, 樊友本. 维持性血液滤过治疗继发性甲状旁腺功能亢进的诊治进展[J]. 中华外科杂志, 2014, 52(9): 713-716.
[6] Dusso, A.S., Thadhani, R. and Slatopolsky, E. (2004) Vitamin D Receptor and Analogs. Seminars in Nephrology, 24, 6-10.
[7] Chen, .RA. and Goodman, W.G. (2004) Role of the Calcium-Sensing Receptor in Parathyroid Gland Physiology. American Journal of Physiology-Renal Physiology, 286, 1005-1011.
[8] 花瞻, 姚力, 张凌, 卞维静. 肾性甲状旁腺功能亢进外科治疗术前高频彩超和99m Tc-MIBI双时相显像的应用[J]. 中国骨质疏松杂志, 2010, 16(8): 580-583.
[9] Akerström, G., Malmaeus, J. and Bergström, R. (1984) Surgical Anatomy of Human Parathyroid Glands. Surgery, 95, 14-21.
[10] 李春红, 田洁. 继发性甲状旁腺功能亢进症的药物治疗进展[J]. 医学综述, 2016, 22(11): 2171-2174.
[11] 陈璐璐. 继发性甲状旁腺功能亢进的内科治疗[J]. 中国实用外科杂志, 2008, 28(3): 174-177.
[12] Tominaga, Y., Matsuoka, S. and Uno, N. (2009) Surgical and Medical Treatment of Secondary Hyperparathyroidism in Patients on Continuous Dialysis. World Journal of Surgery, 33, 2335-2342.
https://doi.org/10.1007/s00268-009-9943-3
[13] 周燕, 周玉坤. 继发性甲状旁腺功能亢进症的药物治疗进展[J]. 实用医学杂志, 2011, 27(24): 4356-4358.
[14] 张凌, 闫彩芸, 姚力. 难治性继发性甲状旁腺功能亢进症的外科治疗[J]. 中国血液净化, 2012, 11(7): 349-351.
[15] Ho, L.C., Hung, S.Y., Wang, H.H., et al. (2016) Parathyroidectomy Associates with Reduced Mortality in Taiwanese Dialysis Patients with Hyperparathyroidism: Evi-dence for the Controversy of Current Guidelines. Scientific Reports, 6, 19150.
https://doi.org/10.1038/srep19150
[16] Ma, T.L., Hung, P.H., Jong, I.C., et al. (2015) Parathyroidectomy Is Associated with Reduced Mortality in Hemodialysis Patients with Secondary Hyperparathyroidism. BioMed Research International, 2015, Article ID: 639587.
https://doi.org/10.1155/2015/639587
[17] Lin, H.C., Chen, C.L., Lin, H.S., et al. (2014) Parathyroidectomy Im-proves Cardiovascular Outcome in Nondiabetic Dialysis Patients with Secondary Hyperparathyroidism. Clinical Endocrinology, 80, 508-515.
https://doi.org/10.1111/cen.12333
[18] Puccini, M., Carpi, A., Cupisti, A., et al. (2010) Total Parathyroidectomy without Autotransplantation for the Treatment of Secondary Hyperparathyroidism Associated with Chronic Kidney Dis-ease: Clinical and Laboratory Long-Term Follow-Up. Biomedicine & Pharmacotherapy, 64, 359-362.
https://doi.org/10.1016/j.biopha.2009.06.006
[19] Wetmore, J.B., Liu, J., Do, T.P., et al. (2016) Changes in Secondary Hyperparathyroidism-Related Biochemical Parameters and Medication Use Following Parathyroidectomy. Nephrology Dialysis Transplantation, 31, 103-111.
https://doi.org/10.1093/ndt/gfv291
[20] Jia, X., Wang, R., Zhang, C., et al. (2015) Long-Term Outcomes of Total Parathyroidectomy with or without Autoimplantation for Hyperparathyroidism in Chronic Kidney Disease: A Me-ta-Analysis. Therapeutic Apheresis and Dialysis, 19, 477-485.
https://doi.org/10.1111/1744-9987.12310
[21] Naranda, J., Ekart, R. and Pečovnik-Balon, B. (2011) Total Parathyroid-ectomy with Forearm Autotransplantation as the Treatment of Choice for Secondary Hyperparathyroidism. Journal of In-ternational Medical Research, 39, 978-987.
https://doi.org/10.1177/147323001103900333
[22] Conzo, G., Della Pietra, C., Tartaglia, E., et al. (2014) Long-Term Function of Parathyroid Subcutaneous Autoimplantation after Presumed Total Parathyroidectomy in the Treatment of Secondary Hyperparathyroidism. A Clinical Retrospective Study. International Journal of Surgery, 12, S165-S169.
https://doi.org/10.1016/j.ijsu.2014.05.019
[23] Kim, B.K., Lee, J. and Sun, W.Y. (2016) Recurrent Hyperparathy-roidism Due to Proliferation of Autotransplanted Parathyroid Tissue in a Multiple Endocrine Neoplasia Type 2A Patient. Annals of Surgical Treatment and Research, 91, 145-148.