Cheng Shih-Ping, Lee Jie-Jen, Liu Tsang-Pai, Chen Han-Hsiang, Wu Chih-Jen, Liu Chien-Liang
Department of Surgery, Mackay Memorial Hospital, Mackay Medical College, 92, Sec. 2, Zhongshan N. Rd, Taipei, 10449, Taiwan.
World J Surg. 2014 Nov;38(11):2838-44. doi: 10.1007/s00268-014-2695-8.
Aluminum overload and accumulation in tissues may lead to skeletal, hematological, and neurological toxicity. The aim of this study was to assess the effects of serum aluminum levels on presentations, postoperative recovery, and symptom improvement in patients undergoing parathyroidectomy for secondary hyperparathyroidism.
From 2008 to 2013, all patients with end-stage renal disease undergoing initial parathyroidectomy were included in the study. Serum aluminum level was measured preoperatively and/or within 1 week after surgery. Preoperative and postoperative biochemical profile and symptoms were compared between the low and high aluminum groups.
A total of 176 patients were included in the study. Of these, 38 (22 %) patients had serum aluminum levels higher than 20 μg/L. A higher percentage of patients in the high aluminum group were on peritoneal dialysis than in the low aluminum group (24 vs. 4 %, p = 0.001). Both groups had similar bone mineral density and changes in biochemical profiles. The preoperative parathyroidectomy assessment of symptoms (PAS) score was not associated with serum aluminum levels (p = 0.349), whereas the postoperative PAS score showed positive association (p = 0.005). There was a negative association between serum aluminum levels and the improvement of total PAS scores (p = 0.001). The high aluminum group had more residual symptoms in three aspects: bone pain (p = 0.038), difficulty getting out of a chair or car (p = 0.045), and pruritus (p = 0.041).
A high serum aluminum level was associated with reduced symptom improvement in patients undergoing parathyroidectomy for secondary hyperparathyroidism.
铝在组织中过载和蓄积可能导致骨骼、血液学及神经毒性。本研究旨在评估血清铝水平对因继发性甲状旁腺功能亢进接受甲状旁腺切除术患者的临床表现、术后恢复及症状改善的影响。
纳入2008年至2013年所有接受初次甲状旁腺切除术的终末期肾病患者。术前及术后1周内测量血清铝水平。比较低铝组和高铝组术前及术后的生化指标和症状。
共176例患者纳入研究。其中，38例（22%）患者血清铝水平高于20μg/L。高铝组接受腹膜透析的患者比例高于低铝组（24%对4%，p = 0.001）。两组骨密度及生化指标变化相似。术前甲状旁腺切除术症状评估（PAS）评分与血清铝水平无关（p = 0.349），而术后PAS评分呈正相关（p = 0.005）。血清铝水平与总PAS评分改善呈负相关（p = 0.001）。高铝组在三个方面残留症状更多：骨痛（p = 0.038）、从椅子或汽车上起身困难（p = 0.045）及瘙痒（p = 0.041）。
血清铝水平高与因继发性甲状旁腺功能亢进接受甲状旁腺切除术患者的症状改善减少有关。
