甲状旁腺全切术对维持性血液透析患者生活质量的影响

doi:10.16138/j.1673-6087.2023.05.005

摘要/Abstract

摘要： 目的探讨甲状旁腺全切术（total parathyroidectomy, TPTX）对维持性血液透析（maintenance hemodialysis, MHD）患者临床指标及生活质量的影响。方法回顾性分析89例继发性甲状旁腺功能亢进症（secondary hyperparathyroidism, SHPT）患者手术前后血清钙、磷、全段甲状旁腺激素（intact parathyroid hormone，IPTH）、碱性磷酸酶、血红蛋白、白蛋白等生化指标变化，应用肾脏病与生活质量问卷36（kidney disease quality of life 36，KDQOL-36）量表和36项简明健康调查问卷（the medical outcome 36-item short form health survey，SF-36）量表对患者进行手术前、后生活质量评估，比较手术前、后生活质量评分变化。结果术后患者乏力、骨痛、皮肤瘙痒等症状明显改善。术后血清钙、磷、碱性磷酸酶、IPTH较术前明显下降（均P<0.01），血红蛋白、白蛋白较术前明显增加（P<0.01）。术前生活质量评分均较低，TPTX后生活质量评分均显著增加（P<0.01）。术前肾病相关生活质量、一般健康相关生活质量、综合生活质量与血红蛋白、白蛋白呈正相关，与年龄呈负相关（均P<0.05）；肾病相关生活质量、综合生活质量与文化程度呈正相关（均P<0.05）；一般健康相关生活质量与血清尿素氮、磷呈负相关（均P<0.05）。结论 TPTX可以显著改善难治性SHPT患者的临床指标，提高生活质量。

关键词: 继发性甲状旁腺功能亢进症, 甲状旁腺全切术, 生活质量, KDQOL-36, SF-36

Abstract: Objective To observe the effect of total parathyroidectomy(TPTX) on quality of life in maintenance hemodialysis (MHD) patients. Methods The changes of biochemical indicators including serum calcium (Ga), phosphorus (P), intact parathyroid hormone (IPTH), alkaline phosphatase (ALP), hemoglobin (Hb) and albumin (ALB) in 61 patients with secondary hyperparathyroidism (SHPT) before and after operation were retrospectively analyzed. KDQOL-36 scale and SF-36 scale were used to evaluate the quality of life of patients before and 1 year after operation. Results Postoperative symptoms such as fatigue, bone pain and skin itching were significantly improved. Postoperative serum calcium, phosphorus, alkaline phosphatase and IPTH were significantly lower than those before operation, and hemoglobin and albumin were significantly higher than those before operation. The preoperative quality of life scores was low, while the quality of life scores were significantly increased after TPTX. Preoperative kidney disease-related quality of life, general health-related quality of life, and comprehensive quality of life were positively correlated with hemoglobin and albumin, and negatively correlated with age. Nephropathy-related quality of life and comprehensive quality of life were positively correlated with education level. General health-related quality of life was negatively correlated with serum urea nitrogen and phosphorus. Conclusions PTX can significantly improve the clinical indicators and the quality of life in refractory SHPT patients.

Key words: Secondary hyperparathyroidism, Total parathyroidectomy, Quality of life, Kidney disease and quality of life questionnaire, 36-item short-form

中图分类号:

R581

马艳, 胡梦圆, 房诗菲, 王琳. 甲状旁腺全切术对维持性血液透析患者生活质量的影响[J]. 内科理论与实践, 2023, 18(05): 334-338.

MA Yan, HU Mengyuan, FANG Shifei, WANG Lin. Effect of total parathyroidectomy on quality of life in maintenance hemodialysis patients[J]. Journal of Internal Medicine Concepts & Practice, 2023, 18(05): 334-338.

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项目	术前	术后	t/Z
血红蛋白（g/L）	107.62±19.55	120.00（111.50，137.00）	-4.15
钙（mmol/L）	2.53（2.42，2.93）	2.35±0.11	-6.14
磷（mmol/L）	2.41±0.49	1.10（1.00，1.24）	-8.19
IPTH（μg/L）	1 643.00（1 110.35，2 202.25）	97.00（69.40，126.40）	-8.19
碱性磷酸酶（μ/L）	211.00（121.60，527.00）	81.57±19.64	-7.96
白蛋白（g/L）	39.59±4.30	45.00（42.90，47.00）	-7.74

维度	术前（分）	术后（分）	Z	P
肾脏病的症状	58.33（43.75，64.58）	77.08（70.83，85.42）	-8.20	<0.01
肾脏病的影响	40.63（31.25，50.00）	62.50（56.25，71.88）	-8.16	<0.01
肾脏病的负担	6.25（0.00，6.25）	25.00（18.75，31.25）	-7.84	<0.01
生理评分	28.08（24.55，32.24）	41.87（35.53，46.67）	-8.04	<0.01
心理评分	36.54（31.57，43.43）	52.42（47.97，55.03）	-8.14	<0.01
KDTA	35.42（26.74，40.97）	55.90（49.13，61.81）	-8.19	<0.01
SF-12	32.10（28.36，38.06）	46.90±3.77	-8.15	<0.01
综合生活质量	36.47（27.71，39.70）	52.33±5.63	-8.19	<0.01

功能	术前（分）	术后1年（分）	Z
PF	40.00（25.00，55.00）	75.00（60.00，95.00）	-8.20
RP	25.00（0.00，50.00）	75.00（50.00，100.00）	-9.43
BP	22.00（10.00，41.00）	82.00（62.00，100.00）	-8.19
GH	25.00（10.00，,45.00）	72.00（52.00，96.00）	-8.20
VT	25.00（10.00，45.00）	75.00（50.00，95.00）	-8.20
SF	25.00（0.00，62.50）	62.50（50.00，100.00）	-7.65
RE	33.33（0.00，66.67）	66.67（66.67，100.00）	-7.56
MH	40.00（8.00，80.00）	76.00（60.00，96.00）	-7.92

项目	KDTA		SF-12		综合生活质量
项目	r	P	r	P	r	P
年龄	-0.28	0.01	-0.28	0.01	-0.29	0.01
文化程度	0.24	0.02	0.16	0.13	0.23	0.03
透析龄	-0.05	0.64	-0.11	0.32	-0.07	0.52
血红蛋白	0.38	0.00	0.31	0.01	0.37	0.00
尿素氮	-0.11	0.29	-0.22	0.04	-0.15	0.15
肌酐	0.13	0.23	-0.07	0.51	0.01	0.50
钾	-0.18	0.09	-0.20	0.06	-0.20	0.06
钙	-0.21	0.05	-0.07	0.50	-0.17	0.11
磷	-0.14	0.18	-0.22	0.04	-0.18	0.10
IPTH	-0.09	0.42	-0.11	0.33	-0.10	0.37
碱性磷酸酶	0.09	0.39	0.10	0.38	0.10	0.36
白蛋白	0.46	0.00	0.37	0.00	0.45	0.00