Goto Norihiko, Tominaga Yoshihiro, Matsuoka Susumu, Sato Tetsuhiko, Katayama Akio, Haba Toshihito, Uchida Kazuharu
Nagoya Daini Red Cross Hospital, 2-9 Myouken-cho, Showa-ku, Nagoya 466-8650, Japan.
Clin Exp Nephrol. 2005 Jun;9(2):138-41. doi: 10.1007/s10157-005-0351-1.
The frequency and prognosis of dilated cardiomyopathy (DCM) caused by secondary hyperparathyroidism (2 degrees HPT) is not known. The purpose of this study was to determine the morbidity of DCM caused by 2 degrees HPT and the efficacy of parathyroidectomy (PTx) in chronic dialysis patients with advanced 2 degrees HPT was analyzed prospectively.
Between November 2000 and January 2003, 237 dialysis patients who underwent total PTx with forearm autograft at our department were enrolled in this study. Cardiac complications that existed before PTx were examined. Ten patients (4%) had DCM without valvular disease (VD) or ischemic heart disease (IHD). In these 10 patients with DCM before operation, we estimated left ventricular (LV) function at 6 months after PTx, according to echocardiography findings and clinical symptoms.
Six months after PTx, left ventricular ejection fraction (LVEF) in these 10 patients was significantly improved, from 31.0 +/- 9.8% before PTx, to 56.8 +/- 13.5% (P = 0.0003), and left ventricular end-diastolic dimension (LVDd) was reduced, from 59.8 +/- 9.7 mm to 46.3 +/- 7.0 mm (P = 0.0014). The symptoms due to DCM and the fall of blood pressure that had occurred during dialysis were clearly improved after PTx.
Advanced 2 degrees HPT can influence LV function, and in patients who suffered from DCM, LV function was dramatically improved by PTx. PTx should be performed immediately in patients with DCM caused by 2 degrees HPT.
继发性甲状旁腺功能亢进（2°HPT）所致扩张型心肌病（DCM）的发生率及预后尚不清楚。本研究旨在确定2°HPT所致DCM的发病率，并前瞻性分析甲状旁腺切除术（PTx）对晚期2°HPT慢性透析患者的疗效。
2000年11月至2003年1月，237例在我科接受前臂自体移植的全甲状旁腺切除术的透析患者纳入本研究。检查PTx前存在的心脏并发症。10例患者（4%）患有无瓣膜病（VD）或缺血性心脏病（IHD）的DCM。在这10例术前患有DCM的患者中，我们根据超声心动图检查结果和临床症状评估PTx术后6个月的左心室（LV）功能。
PTx术后6个月，这10例患者的左心室射血分数（LVEF）显著改善，从PTx前的31.0±9.8%提高到56.8±13.5%（P = 0.0003），左心室舒张末期内径（LVDd）减小，从59.8±9.7mm减小到46.3±7.0mm（P = 0.0014）。PTx术后，DCM所致症状及透析过程中出现的血压下降明显改善。
晚期2°HPT可影响LV功能，对于患有DCM的患者，PTx可显著改善LV功能。对于2°HPT所致DCM患者应立即行PTx。
