甲状旁腺切除术与维持性血液透析患者血管钙化的缓慢进展相关：一项倾向评分匹配的病例对照研究。

Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Nephrology (Carlton). 2022 Apr;27(4):355-362. doi: 10.1111/nep.13986. Epub 2021 Oct 27.

UNLABELLED

Parathyroidectomy has been the mainstay of treatment of severe hyperparathyroidism in patients with kidney failure until the introduction of calcimimetic. Several large observational studies demonstrated the improvement in patient outcomes after parathyroidectomy. The benefit of parathyroidectomy on vascular calcification remains largely unexplored.

AIM

To examine the association between parathyroidectomy and the progression of vascular calcification as well as overall survival in maintenance haemodialysis patients.

METHOD

This is a matched case-control study undertaken between 2012 and 2020. Patients who underwent parathyroidectomy were identified and matched 1:1 to non-parathyroidectomized (non-PTX) haemodialysis patients using propensity score matching method resulting in 120 patients in each arm. Aortic arch calcification (AoAC) score was determined annually in the posteroanterior chest x-ray. The average follow-up period was 38 months.

RESULTS

Baseline demographic, laboratory data and AoAC score were comparable among the two groups of patients. The prevalence of AoAC was 59% in the PTX group and 54% in the non-PTX group (p = .43). Progression of AoAC occurred in 33% in the PTX group and 47% in the non-PTX group (p = .04). Multivariate generalized linear model revealed parathyroidectomy as an independent protective factor [β (95% CI) -1.04 (-1.68, -0.41)] and increased serum calcium as a potentiating factor [β (95% CI) 0.62 (0.25, 0.1)] for progression of AoAC. Linear mixed models revealed an increase in AoAC score in both groups but between group comparisons indicated substantially slower progression in the PTX group. Rapid progression of AoAC was also observed more frequently among non-PTX patients. Death occurred in 7 and 16% in the PTX and non-PTX groups, respectively. Kaplan-Meier survival curve revealed better survival associated with parathyroidectomy (p = .01). More rapid progression of AoAC also correlated with worse survival.

CONCLUSION

Parathyroidectomy was associated with slow progression of vascular calcification in maintenance haemodialysis patients.

目的

探讨甲状旁腺切除术与维持性血液透析患者血管钙化进展及总体生存的关系。

方法

这是一项在 2012 年至 2020 年期间进行的匹配病例对照研究。确定接受甲状旁腺切除术的患者，并使用倾向评分匹配法将其与未接受甲状旁腺切除术（非 PTX）的血液透析患者进行 1:1 匹配，每组各有 120 例患者。每年在前后胸部 X 光片中确定主动脉弓钙化（AoAC）评分。平均随访时间为 38 个月。

结果

两组患者的基线人口统计学、实验室数据和 AoAC 评分无差异。PTX 组 AoAC 的患病率为 59%，非 PTX 组为 54%（p=0.43）。PTX 组 AoAC 进展发生率为 33%，非 PTX 组为 47%（p=0.04）。多变量广义线性模型显示甲状旁腺切除术是 AoAC 进展的独立保护因素[β（95%CI）-1.04（-1.68，-0.41）]，血清钙升高是 AoAC 进展的增强因素[β（95%CI）0.62（0.25，0.1）]。线性混合模型显示两组 AoAC 评分均升高，但组间比较表明 PTX 组进展速度较慢。非 PTX 患者中也观察到 AoAC 快速进展更为频繁。PTX 和非 PTX 组的死亡人数分别为 7 人和 16%。Kaplan-Meier 生存曲线显示甲状旁腺切除术与生存相关（p=0.01）。AoAC 更快进展也与生存不良相关。