Xi Qiu Ping, Xie Xi Sheng, Zhang Ling, Zhang Rui, Xiao Yue Fei, Jin Cheng Gang, Li Yan Bo, Wang Lin, Zhang Xiao Xuan, Du Shu Tong
Department of Nephrology, China-Japan Friendship Hospital, Beijing, China.
Department of Nephrology, Nanchong Central Hospital, Second Clinical Medical Institution of North Sichuan Medical College, Nanchong, China.
Biomed Res Int. 2017;2017:6934706. doi: 10.1155/2017/6934706. Epub 2017 Jun 5.
Secondary hyperparathyroidism (SHPT) usually required parathyroidectomy (PTX) when drugs treatment is invalid. Analysis was done on the impact of different intact parathyroid hormone (iPTH) after the PTX on all-cause mortality.
An open, retrospective, multicenter cohort design was conducted. The sample included 525 dialysis patients with SHPT who had undergone PTX.
404 patients conformed to the standard, with 36 (8.91%) deaths during the 11 years of follow-up. One week postoperatively, different levels of serum iPTH were divided into four groups: A: ≤20 pg/mL; B: 21-150 pg/mL; C: 151-600 pg/mL; and D: >600 pg/mL. All-cause mortality in groups with different iPTH levels appeared as follows: A (8.29%), B (3.54%), C (10.91%), and D (29.03%). The all-cause mortality of B was the lowest, with D the highest. We used group A as reference (hazard ratio (HR) = 1) compared with the other groups, and HRs on groups B, C, and D appeared as 0.57, 1.43, and 3.45, respectively.
The all-cause mortality was associated with different levels of iPTH after the PTX. We found that iPTH > 600 pg/mL appeared as a factor which increased the risk of all-cause mortality. When iPTH levels were positively and effectively reducing, the risk of all-cause mortality also decreased. The most appropriate level of postoperative iPTH seemed to be 21-150 pg/mL.
继发性甲状旁腺功能亢进症（SHPT）在药物治疗无效时通常需要进行甲状旁腺切除术（PTX）。分析PTX后不同的全段甲状旁腺激素（iPTH）水平对全因死亡率的影响。
采用开放、回顾性、多中心队列设计。样本包括525例接受PTX的SHPT透析患者。
404例患者符合标准，在11年的随访期间有36例（8.91%）死亡。术后1周，将不同水平的血清iPTH分为四组：A组：≤20 pg/mL；B组：21 - 150 pg/mL；C组：151 - 600 pg/mL；D组：>600 pg/mL。不同iPTH水平组的全因死亡率如下：A组（8.29%）、B组（3.54%）、C组（10.91%）和D组（29.03%）。B组全因死亡率最低，D组最高。以A组作为参照（风险比（HR）=1），与其他组相比，B组、C组和D组的HR分别为0.57、1.43和3.45。
PTX后全因死亡率与不同的iPTH水平相关。我们发现iPTH>600 pg/mL是增加全因死亡风险的一个因素。当iPTH水平得到积极有效的降低时，全因死亡风险也会降低。术后iPTH的最合适水平似乎为21 - 150 pg/mL。
