Muhetaer Gulimire, Liu Guangyi, Zhang Ling, Jiang Hong
Xinjiang Clinical Research Center for Kidney Disease, Division of Nephrology, Department of Internal Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
Division of Nephrology, Department of Internal Medicine, Qilu Hospital of Shandong University, Qingdao, China.
Front Med (Lausanne). 2022 Jul 22;9:876692. doi: 10.3389/fmed.2022.876692. eCollection 2022.
End-stage renal disease (ESRD) is a global health problem with a high incidence (1) and a steadily increasing prevalence (2). Secondary hyperparathyroidism (SHPT) is a common and serious complication of chronic renal failure (CRF) in dialysis patients (3). It is mainly manifested as parathyroid hyperplasia caused by abnormal calcium and phosphorus metabolism and active vitamin D resistance, resulting in excessive secretion of parathyroid hormone (PTH), which leads to complications such as bone deformity, osteoarthralgia, pruritus, ectopic calcification, and cardiovascular calcification in CKD patients, significantly reducing the quality of life in CKD patients (4, 5). In patients with chronic kidney disease, secondary parathyroid gland hyperplasia needs to be treated as early as possible (6). Currently, there are a variety of treatment options, including vitamin D receptor agonists, xenacax hydrochloride, parathyroidectomy and ablation techniques, etc. (7, 8). Medical treatment is the main choice among these treatments, but it is invalid in patients with severe hyperparathyroidism. So, parathyroidectomy is suggested to do in those patients (9). However, many dialysis patients who have severe cardiopulmonary dysfunction cannot tolerate the trauma caused by surgery as the concept of minimally invasive surgery has been gradually introduced into all fields of surgery and medical treatment. Traditional surgery is no longer the only option. Radiofrequency ablation has been widely applied due to its advantages of less trauma, simple operation, and good repeatability. It has been reported to achieve good effects in treating secondary hyperparathyroidism patients (8). This case reports that one severe secondary hyperparathyroidism patient gets good therapeutic results from parathyroid radiofrequency ablation.
终末期肾病（ESRD）是一个全球性的健康问题，发病率高（1）且患病率持续上升（2）。继发性甲状旁腺功能亢进（SHPT）是透析患者慢性肾衰竭（CRF）常见且严重的并发症（3）。其主要表现为钙磷代谢异常及活性维生素D抵抗导致的甲状旁腺增生，致使甲状旁腺激素（PTH）分泌过多，进而引发慢性肾脏病（CKD）患者出现骨畸形、骨关节炎疼痛、瘙痒、异位钙化和心血管钙化等并发症，显著降低CKD患者的生活质量（4, 5）。在慢性肾脏病患者中，继发性甲状旁腺增生需尽早治疗（6）。目前有多种治疗选择，包括维生素D受体激动剂、西那卡塞盐酸盐、甲状旁腺切除术及消融技术等（7, 8）。药物治疗是这些治疗方法中的主要选择，但对严重甲状旁腺功能亢进患者无效。因此，建议对这些患者进行甲状旁腺切除术（9）。然而，随着微创手术理念逐渐引入外科和医疗的各个领域，许多患有严重心肺功能障碍的透析患者无法耐受手术造成的创伤。传统手术已不再是唯一选择。射频消融因其创伤小、操作简单、重复性好等优点已被广泛应用。据报道，其在治疗继发性甲状旁腺功能亢进患者方面取得了良好效果（8）。本病例报告了一名严重继发性甲状旁腺功能亢进患者通过甲状旁腺射频消融获得了良好的治疗效果。
