甲状旁腺切除术对 5 期慢性肾脏病患者血浆甲状旁腺激素片段和心率变异性的影响。
Effects of parathyroidectomy on plasma PTH fragments and heart rate variability in stage 5 chronic kidney disease patients.
机构信息
Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.
Department of Nephrology, Taizhou People's Hospital, Taizhou, China.
出版信息
Ren Fail. 2021 Dec;43(1):890-899. doi: 10.1080/0886022X.2021.1931318.
INTRODUCTION
Circulating intact parathyroid hormone (iPTH) levels include full-length (1-84) PTH and long C-PTH fragments, but primarily (7-84) PTH, which have been reported to have antagonistic effects on the bones and kidneys. However, their effects on the cardiovascular system remain unclear. In this study, the relationships between the plasma PTH fragments levels and heart rate variability (HRV) in stage 5 chronic kidney disease (CKD5) patients are explored. Furthermore, the effects of parathyroidectomy (PTX) on the above indices are investigated.
METHODS
In this cross-sectional study, 164 healthy controls and 354 CKD5 patients, including 208 secondary hyperparathyroidism (SHPT) subgroup with PTX, were enrolled. Circulating (7-84) PTH levels were calculated by subtracting plasma (1-84) PTH levels from iPTH levels. The HRV parameters were measured using a 24-hour Holter.
RESULTS
The baseline levels of plasma iPTH, (1-84) PTH, and (7-84) PTH in the CKD5 patients were 930.40 (160.65, 1792.50) pg/mL, 448.60 (99.62, 850.45) pg/mL, and 468.20 (54.22, 922.55) pg/mL, respectively. In the CKD5 patients, plasma (1-84) PTH levels were independently correlated with the standard deviation of the normal-to-normal R-R intervals (SDNN) and the standard deviation of the five-minute average of the normal R-R intervals (SDANN). With a median follow up time of 6.50 months after PTX in the SHPT patients ( = 30), improved SDNN and SDANN markers were related with decreased (1-84) PTH levels. Furthermore, an improved SDNN was related with decreased (7-84) PTH levels.
CONCLUSIONS
The CKD5 patients' baseline (1-84) PTH levels were correlated with the SDNN and SDANN. After PTX, an improved SDNN was related with decreased (1-84) PTH and (7-84) PTH levels, while improved SDANN was related with decreased (1-84) PTH levels. No antagonistic effects of (1-84) PTH and (7-84) PTH on HRV were found in the CKD5 patients.
简介
循环完整甲状旁腺激素 (iPTH) 水平包括全长 (1-84) PTH 和长 C-PTH 片段，但主要是 (7-84) PTH，据报道其对骨骼和肾脏有拮抗作用。然而，它们对心血管系统的影响尚不清楚。本研究探讨了 5 期慢性肾脏病 (CKD5) 患者血浆 PTH 片段水平与心率变异性 (HRV) 之间的关系。此外，还研究了甲状旁腺切除术 (PTX) 对上述指标的影响。
方法
本横断面研究纳入了 164 名健康对照者和 354 名 CKD5 患者，其中 208 名为继发性甲状旁腺功能亢进症 (SHPT) 亚组接受了 PTX。通过从 iPTH 水平中减去血浆 (1-84) PTH 水平来计算循环 (7-84) PTH 水平。使用 24 小时动态心电图仪测量 HRV 参数。
结果
CKD5 患者的基础 iPTH、(1-84) PTH 和 (7-84) PTH 水平分别为 930.40(160.65，1792.50)pg/ml、448.60(99.62，850.45)pg/ml 和 468.20(54.22，922.55)pg/ml。在 CKD5 患者中，血浆 (1-84) PTH 水平与正常 R-R 间期标准差 (SDNN) 和正常 R-R 间期五分位平均标准差 (SDANN) 独立相关。在 SHPT 患者接受 PTX 后中位随访时间为 6.50 个月（n=30）时，SDNN 和 SDANN 标志物的改善与 (1-84) PTH 水平的降低有关。此外，SDNN 的改善与 (7-84) PTH 水平的降低有关。
结论
CKD5 患者的基础 (1-84) PTH 水平与 SDNN 和 SDANN 相关。PTX 后，SDNN 的改善与 (1-84) PTH 和 (7-84) PTH 水平的降低有关，而 SDANN 的改善与 (1-84) PTH 水平的降低有关。在 CKD5 患者中，未发现 (1-84) PTH 和 (7-84) PTH 对 HRV 有拮抗作用。
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