Zhou Bin, Zhu Lei, Xiang Cheng, Cheng Feng, Zhu Xi, Zhou Yi, Wang Yong
Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
Department of Thyroid and Breast Surgery, Lishui Hospital of Zhejiang University, Lishui, 323000, Hangzhou, China.
BMC Surg. 2021 May 1;21(1):226. doi: 10.1186/s12893-021-01222-2.
Forearm autotransplantation after parathyroidectomy has turned into the standard method for secondary hyperparathyroidism (SHPT) treatment in chronic kidney disease patients. Our study aimed to explore the effects of three methods including muscle, subcutaneous and muscle + subcutaneous transplant methods on SHPT.
Seventy five SHPT patients were enrolled and assigned into the muscle + subcutaneous (M + S) (n = 26), muscle (M) (n = 35), and subcutaneous (S) (n = 14) groups. The operation efficacy evaluation included preoperative and postoperative biological characteristics such as parathyroid hormone (PTH), serum phosphorus, serum calcium and alkaline phosphatase (ALP). The data were recorded from pre-operation time point to 1, 2, 3, 6, 12, 18, 24 month (mo) postoperation periods. After operation, short-form health survey (SF-36) scores was made for life quality identification at 1, 2, 3, 6, 12, 24 time points. Symptoms about SHPT including bone pain, fracture, pruritus, and coronary artery calcification were followed-up based on the scale.
Compared with the preoperative record, all the M + S, M, and S groups showed postoperative decreased levels of PTH, serum phosphorus, serum calcium, calcium-phosphorus. In M + S group, the PTH and serum calcium level kept more steady compared with the M and S groups during a 24 mo duration observation. After this, a SF-36 score scale which represents the life quality show M + S group got more scores at 3, 6, 12, 18 and 24 mo points. At last, the incidence of SHPT associated symptoms including Bone pain, Fracture, Pruritus, and Coronary artery calcification in M + S group were decreased compared with M and S groups at 1, 3, 6, 12 and 24 mo post-operation time points.
M + S seems to be an efficient method for medical treatment of SHPT patients in the control of PTH and serum calcium. This mixed transplant strategy improves the biochemical characterizes compared with M and S groups in SHPT patients. Furthermore, the M + S method make beneficial on clinical outcomes and life quality of patients.
甲状旁腺切除术后自体前臂移植已成为慢性肾脏病患者继发性甲状旁腺功能亢进（SHPT）治疗的标准方法。我们的研究旨在探讨肌肉、皮下和肌肉+皮下三种移植方法对SHPT的影响。
纳入75例SHPT患者，分为肌肉+皮下（M+S）组（n=26）、肌肉（M）组（n=35）和皮下（S）组（n=14）。手术疗效评估包括术前和术后的生物学特征，如甲状旁腺激素（PTH）、血清磷、血清钙和碱性磷酸酶（ALP）。数据记录从术前时间点至术后1、2、3、6、12、18、24个月（mo）。术后，在1、2、3、6、12、24个时间点进行简短健康调查（SF-36）评分以评估生活质量。基于该量表对SHPT相关症状，包括骨痛、骨折、瘙痒和冠状动脉钙化进行随访。
与术前记录相比，所有M+S组、M组和S组术后PTH、血清磷、血清钙、钙磷水平均降低。在24个月的观察期内，M+S组的PTH和血清钙水平与M组和S组相比保持更稳定。此后，代表生活质量的SF-36评分量表显示，M+S组在3、6、12、18和24个月时得分更高。最后，在术后1、3、6、12和24个月时间点，M+S组SHPT相关症状（包括骨痛、骨折、瘙痒和冠状动脉钙化）的发生率低于M组和S组。
M+S似乎是控制SHPT患者PTH和血清钙的有效治疗方法。与SHPT患者的M组和S组相比，这种混合移植策略改善了生化特征。此外，M+S方法对患者的临床结局和生活质量有益。
