Tanaka Motoko, Itoh Kazuko, Matsushita Kazunori, Matsushita Kazutaka, Fukagawa Masafumi
Department of Nephrology, Akebono Clinic, 5-1-1, Shirafuji, Kumamoto 861-4112, Japan.
Ther Apher Dial. 2005 Feb;9(1):48-52. doi: 10.1111/j.1774-9987.2005.00214.x.
Secondary hyperparathyroidism (SHPT) is a major complication of hemodialysis patients. Recently, percutaneous ethanol injection therapy (PEIT) has become a useful alternative treatment to parathyroidectomy (PTx). In this study, we evaluate the usefulness of PEIT for SHPT according to Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines. We studied 28 patients on hemodialysis with high intact-PTH (>400 pg/mL) and one to four swollen parathyroid glands detected by power Doppler ultrasonography. They were classified into Group 1 (N = 16), with 1 or 2 swollen glands, Group 2 (N = 5), with 3 or 4 swollen glands, and Group 3 (N = 7), high-risk patients for PTx. We compared serum intact-PTH levels 1 year after PEIT according to K/DOQI guidelines among these groups. We also evaluated the effectiveness of PEIT and PTx by comparing intact-PTH levels in 21 patients 1 year after PEIT (groups 1 and 2) with 11 patients after PTx. In Group 1, adequate intact-PTH levels were noted in 13 of 16 (81.2%) patients after PEIT, while 1 patient of 5 (20%) was achieved in Group 2, and 2 of 7 (28.6%) patients of Group 3. Adequate intact-PTH levels were attained in 14 of 21 (66.7%) patients of the PEIT group but only in 2 of 11 (18.2%) patients of the PTx group. Our results suggest that PEIT is a useful treatment for SHPT, especially in patients with one or two swollen glands. Through appropriate selection of patients for PEIT and correct injection of ethanol into the enlarged parathyroid gland, PEIT could accomplish better outcomes based on K/DOQI guidelines.
继发性甲状旁腺功能亢进（SHPT）是血液透析患者的主要并发症。近年来，经皮乙醇注射疗法（PEIT）已成为甲状旁腺切除术（PTx）的一种有效替代治疗方法。在本研究中，我们根据肾脏病预后质量倡议（K/DOQI）指南评估PEIT对SHPT的有效性。我们研究了28例血液透析患者，其血中完整甲状旁腺激素水平较高（>400 pg/mL），且经能量多普勒超声检测发现有1至4个甲状旁腺肿大。他们被分为1组（N = 16），有1或2个肿大的腺体；2组（N = 5），有3或4个肿大的腺体；3组（N = 7），为PTx的高危患者。我们根据K/DOQI指南比较了这些组在PEIT后1年的血清完整甲状旁腺激素水平。我们还通过比较PEIT后1年的21例患者（1组和2组）与PTx后的11例患者的完整甲状旁腺激素水平，评估了PEIT和PTx的有效性。在1组中，PEIT后16例患者中有13例（81.2%）的完整甲状旁腺激素水平达到适当水平，而2组5例患者中有1例（20%）达到，3组7例患者中有2例（28.6%）达到。PEIT组21例患者中有14例（66.7%）达到适当的完整甲状旁腺激素水平，而PTx组11例患者中只有2例（18.2%）达到。我们的结果表明，PEIT是治疗SHPT的一种有效方法，尤其是对于有1或2个肿大腺体的患者。通过适当选择PEIT患者并将乙醇正确注射到肿大的甲状旁腺中，根据K/DOQI指南，PEIT可以取得更好的效果。
