Ruderman Irene, Rajapakse Chamith S, Xu Winnie, Tang Sisi, Robertson Patricia L, Toussaint Nigel D
Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia.
Bone Rep. 2021 Aug 24;15:101120. doi: 10.1016/j.bonr.2021.101120. eCollection 2021 Dec.
Secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD) has a significant effect on bone, affecting both trabecular and cortical compartments. Although parathyroidectomy results in biochemical improvement in mineral metabolism, changes in bone microarchitecture as evaluated by high-resolution imaging modalities are not known. Magnetic resonance imaging (MRI) provides in-depth three-dimensional assessment of bone microarchitecture, as well as determination of mechanical bone strength determined by finite element analysis (FEA).
We conducted a single-centre longitudinal study to evaluate changes in bone microarchitecture with MRI in patients with SHPT undergoing parathyroidectomy. MRI was performed at the distal tibia at baseline (time of parathyroidectomy) and at least 12 months following surgery. Trabecular and cortical topological parameters as well as bone mechanical competence using FEA were assessed.
Fifteen patients with CKD (12 male, 3 female) underwent both MRI scans at the time of surgery and at least 12 months post-surgery. At baseline, 13 patients were on dialysis, one had a functioning kidney transplant, and one was pre-dialysis with stage 5 CKD. Seven patients received a kidney transplant following parathyroidectomy prior to follow-up MRI. MRI parameters in patients at follow up were consistent with loss in trabecular and cortical bone thickness (p = 0.006 and 0.03 respectively). Patients who underwent a kidney transplant in the follow-up period had reduction in trabecular thickness (p = 0.05), whereas those who continued on dialysis had reduction in cortical thickness (p = 0.04) and mechanical bone strength on FEA (p = 0.03).
Patients with severe SHPT requiring parathyroidectomy have persistent changes in bone microarchitecture at least 12 months following surgery with evidence of ongoing decline in trabecular and cortical thickness.
慢性肾脏病（CKD）患者的继发性甲状旁腺功能亢进（SHPT）对骨骼有显著影响，累及小梁骨和皮质骨。尽管甲状旁腺切除可使矿物质代谢在生化指标上得到改善，但通过高分辨率成像方式评估的骨微结构变化尚不清楚。磁共振成像（MRI）可对骨微结构进行深入的三维评估，还能通过有限元分析（FEA）测定骨力学强度。
我们开展了一项单中心纵向研究，以评估接受甲状旁腺切除术的SHPT患者骨微结构的MRI变化。在基线期（甲状旁腺切除时）和术后至少12个月对胫骨远端进行MRI检查。评估小梁骨和皮质骨的拓扑参数以及使用FEA的骨力学性能。
15例CKD患者（12例男性，3例女性）在手术时和术后至少12个月均接受了MRI扫描。基线时，13例患者接受透析治疗，1例有功能正常的肾移植，1例为5期CKD且处于透析前状态。7例患者在随访MRI之前于甲状旁腺切除术后接受了肾移植。随访患者的MRI参数与小梁骨和皮质骨厚度减少一致（分别为p = 0.006和0.03）。随访期内接受肾移植的患者小梁骨厚度减少（p = 0.05），而继续接受透析的患者皮质骨厚度减少（p = 0.04）且FEA测定的骨力学强度降低（p = 0.03）。
需要进行甲状旁腺切除术的重度SHPT患者在术后至少12个月骨微结构持续变化，有证据表明小梁骨和皮质骨厚度持续下降。
