目的:分析难治性继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)患者高全段甲状旁腺激素(intact parathyroid hormone,iPTH)的相关因素. 方法:回顾性总结134例行甲状旁腺切除术(parathyroidectomy,PTX)治疗的终末期肾病患者资料,男、女各67例,平均年龄49.5±11.8岁(24 ～ 75岁)；平均透析龄111.8±55.9月(0～252月),采用多因素线性回归分析PTX前血清iPTH和年龄、性别、透析龄以及PTX前血清校正钙、磷和碱性磷酸酶(alkaline phosphatase,ALP)的相关性. 结果:134例患者中,透析龄≥15年15例(11.2％),10～15年23例(17.2％),5～10年75例(55.9％),≤5年21例(15.7％)；PTX前血iPTH 1 958±785ng/L(479 ～4 200 ng/L)、血清磷2.27±0.59 mmol/L(0.64 ～4.17 mmol/L)、血清校正钙2.56±0.22 mmol/L( 1.96～3.35 mmol/L),血清ALP的中位数373 IU/L(41 ～2 752 IU/L).多因素凹归分析表明,患者透析龄以及PTX前的血磷、ALP与iPTH相关,透析龄每增加1月,iPTH增加4.8 ng/L(95％ CI2.31 ～7.36,P=0.000),血磷每增加lmmol/L,iPTH增加437 ng/L(95％ CI 154.16 ～719.92,P=0.003),血ALP每增加1 IU/L,iPTH增加0.5 ng/L(95％ CI 0.23 ～0.80,P =0.000). 结论:难治性SHPT患者PTx前高iPTH与术前的血磷、血ALP和透析龄相关,与性别、年龄和血清校正钙水平无明显相关性,提示控制血磷在防治发生难治性SHPT方面可能更为重要.%To analyze the associations of intact parathyroid hormone (iPTH) in patients with refractory secondary hyperparathyroidism (SHPT). Methodology: One hundred and thirty four cases with end-stage renal disease and refractory SHPT treated with parathyroidectomy (FfX) were retrospectively studied. They were 67 males and 67 females with an average age of 49. 5 ±11.8 years old. Their clinical data including age, gender, primary causes of renal disease,therapeutic modalities,dialysis vintage of the patients before PTX were collected. The average dialysis vintage was (112 ±55. 9) months (0-252 months). The levels of serum iPTH,calcium,phosphorus and alkaline phosphatase (ALP) were detected before PTX. Multivariate linear regression was used to analyze the relationship between serum iPTH levels and age,gender, vintage, corrected serum calcium, serum phosphorus and ALP levels. Results: Of the 134 cases, 15 (11.2%) were 15 years or more, 23 (17.2*) were 10 ~ 15 years,75 (55.9%) were 5 - 10 years,and 21 (15.7%)were 5 years or less of dialysis vintage. The level of serum iPTH (mean ± SD) before PTX was (1 958 ± 785) pg/ml (479 ~ 4 200 pg/ml). The level of serum phosphorus ( mean ± SD) before PTX was (2. 27 ± 0. 59) mmol/L (0. 64 ~ 4. 17 mmol/L). The corrected serum calcium levels ( mean ± SD) before PTX was ( 2. 56 ± 0. 22) mmol/L ( 1.96 - 3.35 mmol/L). The median value for serum ALP concentrations before PTX was 373 IU/L (41 -2 752 IU/L). Multivariate linear regression showed that dialysis vintage [ B = 4. 8,95 % confidence interval (Cl) 2.31 ~ 7.36, P = 0.000 ] , serum phosphorus levels (B =437,95% CI 154. 16-719.92,P = 0. 003),serum ALP concentrations (B =0.5,95% CI0.23-0.80,f = 0. 000) were associated with serum iPTH before PTX. That meant before PTX,serum iPTH was increased by 4. 8 ng/L with increasing of one month of dialysis vintage. The level of serum iPTH was increased by 437 ng/L with increasing of one mmol/L of serum phosphorus. The serum iPTH was increased by 0. 5 ng/L with increasing of one IU/L of serum ALP. Conclusion:The serum iPTH in patients with refractory SHP was correlated with dialysis vintage,serum phosphorus and ALP levels before PTX,while it was not correlated with gender,age and corrected serum calcium levels. Strictly control of serum phosphorus might be more important to prevent refractory SHPT.
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