甲狀旁腺切除對尿毒癥繼發性甲狀旁腺功能亢進癥患者認知功能及生存質量的影響

郭煥開 楊曉冉 梁錦云 劉彩玲 徐慶東

[摘要]目的 探討甲狀旁腺全切除加自體移植術對尿毒癥繼發性甲狀旁腺功能亢進癥（SHPT）患者認知功能及生存質量的影響。方法 選取2015年1月～2016年10月我院收治的58例尿毒癥SHPT患者作為研究對象，既往甲狀旁腺全切除史。對術前及術后1年患者的認知功能及生活質量的改善情況進行統計分析。結果 手術切除甲狀旁腺后術后第1、3、7、14、21天患者血甲狀旁腺激素（iPTH）、血鈣、血磷、堿性磷酸酶（ALP）低于手術前，血紅蛋白（Hb）水平高于手術前，差異有統計學意義（P<0.05）；手術后1年MMSE評分為（15.02±1.35）分，高于手術前的（7.54±0.21）分，差異有統計學意義（P<0.05）；術后1年，SF-36總分明顯高于手術前，差異有統計學意義（P<0.05），其PF、RP、BP、GH明顯高于術前，差異有統計學意義（P<0.05），患者手術前后VT、SF、RE、MH比較，差異無統計學意義（P>0.05）；術后1年OHR評分明顯高于手術前，差異有統計學意義（P<0.05），其SPL、EKD、Sleep得分高于術前，差異有統計學意義（P<0.05），患者手術前后余項目比較，差異無統計學意義（P>0.05）。結論 甲狀旁腺切除能夠提高SHPT患者的認知能力，并有效改善其生活質量，值得臨床推廣。

[關鍵詞]甲狀旁腺切除；尿毒癥；認知功能；生存質量

[中圖分類號] R582+.1 [文獻標識碼] A [文章編號] 1674-4721（2018）4（b）-0008-04

Influence of parathyroidectomy in the cognitive function and quality of life for uremia patients with secondary hyperparathyroidism

GUO Huan-kai YANG Xiao-ran LIANG Jin-yun LIU Cai-ling XU Qing-dong

Department of Nephrology，Jiangmen Central Hospital，Guangdong Province，Jiangmen 529000，China

[Abstract]Objective To investigate the influence of total parathyroidectomy combined with autologous transplantation in the cognitive function and quality of life for uremia patients with secondary hyperparathyroidism （SHPT）.Methods A total of 58 SHPT patients with uremia who were admitted to our hospital from January 2015 to October 2016 were selected as the study subjects.They were with the past history of total resection of the parathyroid gland.The improvement of cognitive function and quality of life in the patients before the surgery and one year after the surgery were statistically analyzed.Results Blood parathyroid hormone （iPTH），serum calcium，serum phosphorus，and alkaline phosphatase （ALP） were lower than those before surgery on the 1st，3rd，7th，14th，and 21st days after surgery for parathyroidectomy，the level of hemoglobin （Hb） was higher than that before surgery，and the difference was statistically significant （P<0.05）；the MMSE score was （15.02±1.35） points at one year after the surgery，which was higher than that of （7.54±0.21） points before the surgery，and the difference was statistically significant （P<0.05）；at 1 year after surgery，the total score of SF-36 was significantly higher than that before surgery，and the difference was statistically significant （P<0.05）.The PF，RP，BP，and GH were significantly higher than those before the surgery，and the difference was statistically significant （P<0.05）.There was no statistically significant difference in VT，SF，RE，and MH before and after the surgery （P>0.05）.The OHR score at one year after the surgery was significantly higher than that before the surgery，and the difference was statistically significant （P<0.05）.The SPL，EKD，and Sleep scores were higher than those before the surgery，and the difference was statistically significant （P<0.05）.There was no statistically significant difference in the other items before and after surgery （P>0.05）.Conclusion Parathyroidectomy can improve the cognitive ability in the patients with uremia complicated with secondary hyperparathyroidism and effectively improve their quality of life，which is worthy of clinical promotion.

[Key words]Parathyroidectomy；Uremia；Cognitive function；Quality of life

尿毒癥繼發性甲狀旁腺功能亢進癥（SHPT）是尿毒癥透析后較常見的并發癥[1-2]。我國腎病的發病率較高，治療雖有進展，但臨床效果常不佳，患者常出現鈣磷代謝異常、骨痛、骨異常等，生活質量也往往較低，因此需改善營養不良，避免轉移性鈣化，改善心血管病變，糾正貧血，提高生活質量。

認知功能損害（cognitive mipairment，CI）也被稱為認知力減退，有報道顯示，尿毒癥患者CI的總體發病率為16%～38%，近3倍于正常人群。青年及中年尿毒癥患者CI的發病率為10%～30%，75歲以上的尿毒癥患者中30%～55%存在CI[3-4]。導致尿毒癥患者CI的因素很多，SHPT是CI較為關鍵的危險因素。高甲狀旁腺激素（iPTH）所導致的腦鈣儲存量增加與神經傳導阻滯有關[5]。……