尿毒症继发难治性甲状旁腺功能亢进症患者心脏瓣膜钙化情况及影响因素

摘要

目的：观察尿毒症继发甲状旁腺功能亢进症（ SHPT）患者心脏瓣膜钙化（ VC）情况，并分析其影响因素。方法尿毒症难治性SHPT患者83例，拟行甲状旁腺切除术（ PTX）治疗。患者均于透析前测定血红蛋白（ Hb）、血清白蛋白（ Alb）、血钙、血磷、碱性磷酸酶（ ALP）、C反应蛋白（ CRP）及全段甲状旁腺激素（ iPTH）等指标，并于透析次日采用超声心动图测量心脏瓣膜和其他心脏结构、功能指标。根据VC情况将患者分为VC组与无VC组，比较两组患者实验室以及心脏超声检测指标，分析心脏VC的影响因素。结果难治性SHPT患者VC发生率达47％（39/83），以二尖瓣后叶瓣环钙化（46．15％，18/39）、合并主动脉瓣钙化为主（43．59％，17/39），单纯主动脉钙化并不常见（10．26％，4/39）。43．37％（36/83）的患者并发二尖瓣或主动脉瓣反流。 VC组SBP、DBP、iPTH、ALP、LA、LVDd水平均明显高于无VC组（P均﹤0．05）。 Logistic回归分析显示，iPTH、LA是难治性SHPT患者发生VC的影响因素。结论尿毒症难治性SHPT患者VC发生率高，iPTH是VC发生的影响因素。此类患者应尽早行PTX，降低血iPTH水平，防治瓣膜钙化进展，改善预后。%Objective To analyze the incidence of heart valve calcification(VC) and the possible factors of heart valve calcification among patients with refractory secondary hyperparathyroidism.Methods A total of 83 cases with refrac-tory SHPT treated with parathyroidectomy (PTX) were retrospectively studied.The levels of hemoglobin(Hb), albumin ( Alb) , calcium( Ca2+) , phosphorus( P) , alkaline phosphatase( ALP) , CRP and intact parathyroid hormone( iPTH) were detected before hemodialysis.Heart valve calcification and parameters relating to cardiac structure and function were as-sayed, the patients were then assigned into the VC group and the no VC group.Laboratory and clinical data were compared between the two groups, then analyzed the possible factors contribute to VC.Results The incidence of VC were 47%(39/83)in SHPT patients.Mitral valve calcification were found in 18 patients(46.15%), mitral and aortic valve calcifi-cation in 17 patients(43.59%), aortic valve calcification in 4 patients (10.26%), 43.37% (36/83) of patients had a heart valve regurgitation( mitral valve and aortic valve) .The level of SBP, DBP, iPTH, ALP, LA, LVDd in VC group were significantly higher than those in no VC group( all P<0.05) .Logistic regression found that PTH and LA were the in-dependent factors for VC.Conclusions The incidence of VC in refractory SHPT are high, The level of iPHT is the inde-pendent impact factors for VC in refractory SHPT.Such patients should be considered for PTX as early as possible in order to slow the progress of VC and improve prognosis.