维持性血液透析患者继发性甲状旁腺功能亢进的微波消融与甲状旁腺切除术对比

Microwave ablation vs. parathyroidectomy for secondary hyperparathyroidism in maintenance hemodialysis patients.

作者信息

Jiang Binghu, Wang Xiaoyun, Yao Zhiyong, Wu Hongfei, Xiao Leijuan, Gong Hai, Gao Zhanhui

机构信息

Department of Radiology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China.

Department of Nephrology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China.

出版信息

Hemodial Int. 2019 Apr;23(2):247-253. doi: 10.1111/hdi.12740. Epub 2019 Feb 28.

DOI:10.1111/hdi.12740

PMID:30815995

Abstract

INTRODUCTION

Secondary hyperparathyroidism (SHPT) is a serious and common problem in patients undergoing maintenance hemodialysis. Minimally invasive microwave ablation (MWA) has been used to treat SHPT and shows some advantages. However, its efficacy is still undefined. The primary purpose of this study was to determine the efficacy and safety of MWA compared to total parathyroidectomy plus forearm autotransplantation.

METHODS

The SHPT patients who were undergoing maintenance hemodialysis (follow-up for 6 to 24 months after treatments) were divided into a MWA group (n = 33) and a parathyroidectomy group (n = 48). The efficacy (serum intact parathyroid hormone [iPTH], calcium, and phosphorus levels) and safety (hoarseness, hypocalcaemia, and persistently low iPTH) were compared between the two groups. Additionally, the study explored potential predictors of response to MWA by a logistic regression analysis.

FINDINGS

There were no significant differences in baseline characteristics between the two groups. The rates of achieving the recommended goal for iPTH were significantly higher in the MWA group than that in the parathyroidectomy group at all follow-up times: 57.58% vs. 12.50% at one-day (P < 0.001), 45.45% vs. 16.67% at 1-week (P = 0.005), 57.58% vs. 16.67% at 2-week (P < 0.001), 57.58% vs. 22.92% at 1-month (P = 0.002), and 69.70% vs. 35.42% at 3-month (P = 0.002), 76.47% vs. 28.57% at 6-month (P = 0.005), 87.50% vs. 47.37% at 12-month (P = 0.008), and 81.82% vs. 52.63% at 24-month (P = 0.015), respectively. However, there were no significant differences for phosphorus or calcium at any of the follow-up times (P > 0.05). The persistently low iPTH was more in the parathyroidectomy group (64.6%) than that in the MWA group (0%) (P < 0.001), but there was no significant difference in hoarseness or hypocalcaemia (P > 0.05). Baseline levels of iPTH (P = 0.021) and patient age (P = 0.011) were determined as predictors by univariate logistic regression analysis.

CONCLUSION

The MWA could be an alternative to parathyroidectomy for SHPT but its eventual superiority has to be demonstrated by a proper study.

摘要

引言

继发性甲状旁腺功能亢进（SHPT）是维持性血液透析患者中一个严重且常见的问题。微创微波消融（MWA）已被用于治疗SHPT并显示出一些优势。然而，其疗效仍不明确。本研究的主要目的是确定与甲状旁腺全切术加前臂自体移植相比，MWA的疗效和安全性。

方法

将接受维持性血液透析的SHPT患者（治疗后随访6至24个月）分为MWA组（n = 33）和甲状旁腺切除术组（n = 48）。比较两组的疗效（血清完整甲状旁腺激素[iPTH]、钙和磷水平）和安全性（声音嘶哑、低钙血症和持续性低iPTH）。此外，本研究通过逻辑回归分析探索了MWA反应的潜在预测因素。

结果

两组的基线特征无显著差异。在所有随访时间，MWA组达到iPTH推荐目标的比例均显著高于甲状旁腺切除术组：术后1天分别为57.58% 对12.50%（P < 0.001），1周时为45.45% 对16.67%（P = 0.005），2周时为57.58%对16.67%（P < 0.001），1个月时为57.58%对22.92%（P = 0.002），3个月时为69.70%对35.42%（P = 0.002），6个月时为76.47%对28.57%（P = 0.005），12个月时为87.50%对47.37%（P = 0.008），24个月时为81.82%对52.63%（P = 0.015）。然而，在任何随访时间，磷或钙水平均无显著差异（P > 0.05）。持续性低iPTH在甲状旁腺切除术组（64.6%）中比MWA组（0%）更多（P < 0.001），但声音嘶哑或低钙血症方面无显著差异（P > 0.05）。单因素逻辑回归分析确定iPTH的基线水平（P = 0.021）和患者年龄（P = 0.011）为预测因素。