摘要
目的通过对尿毒症继发难治性甲状旁腺功能亢进行甲状旁腺切除术后的甲状旁腺组织病理观察,分析不同程度甲状旁腺激素水平患者的病理结果是否存在差异。方法在2009年9月~2012年1月期间在中日友好医院进行甲状旁腺切除手术(PTX)的46例尿毒症透析患者的甲状旁腺组织进行病理形态分析。根据甲状旁腺激素(i PTH)水平分组,A组i PTH<1000pg/ml,B组i PTH1000pg/ml^2000pg/ml,C组i PTH>2000pg/ml;同时依据透析龄10年以上和10年以下分2组。比较3组间实验室指标的差异及甲状旁腺组织的病理形态差异;比较不同透析龄分组,甲状旁腺组织的病理形态差异。结果 3组间Ca、P和透析龄之间均无显著性差异(P>0.05);3组i PTH组间均有显著性差异(P=0.000);3组间比较碱性磷酸酶(ALP)有显著性差异[(216.00±196.81)U/L,(463.45±363.35)U/L,(619.55±377.50)U/L,P=0.014],ALP的组间均值随i PTH的升高而大幅度升高,与i PTH的升高成正比。病理形态比较3组中均出现陈旧性出血、嗜酸性细胞、水样透明细胞、腺样结构及病变区钙化和血管壁钙化等病变。以透析龄10年为界进行比较,甲状旁腺出现钙化、血管壁钙化的比例分别为透析10年以下组23.1%和透析10年以上组78.9%,2组间具有显著性差异(P=0.000)。结论 i PTH的水平与ALP的升高呈正相关;钙化和血管壁钙化与透析时间长短相关;而i PTH水平的高低与继发甲状旁腺功能亢进病理变化无相关性。
Objectives To analyze the relationship between parathyroid hormone （PTH） level and pathological changes in parathyroid of hyperparathyroidism through pathological examination of the surgical samples after parathyroidectomy （PTX）. Methods A total of 46 dialysis patients with refractory hyperparathy- roidism and treated with PTX in China-Japan Friendship Hospital during the period from Sep. 2009 to Jan. 2012 were enrolled in this study. They were divided into 3 groups based on iPTH level： group A （iPTH 〈 1,000 pg/ml）, group B （iPTH 1,000-2,000 pg/ml）, and group C （iPTH 〉2,000 pg/ml）. They were also divided into dialysis age 〉10 years group and dialysis age 〈10 years group. Laboratory examinations and pathological findings in the parathyroid surgical samples were compared among the 3 groups. Pathological findings in the parathyroid surgical samples were also compared in patients with different dialysis age. Results Ca, P and dialysis age had no differences （P〉0.05）, but iPTH and alkaline phosphatase （ALP） levels were significantly different among the 3 groups （P=0.000 and 0.014, respectively）. Group C had the highest mean ALP value, followed by group B and group A. Old hemorrhagic loci, eosinophilic cells, transparent cells, adenoid structure, tissue calcification, and vascular wall calcification were seen in the 3 groups. The rate of calcification in parathyroid gland and vascular wall was 23.1% in patients with dialysis age of 〈10 years, and was 78.9% in those with dialysis age of 〉10 years （P=-0.000）. Conclusion iPTH levels were positively correlated with the level of ALP. Calcification in parathyroid gland and vascular wall was positively correlated with dialysis age. However, iPTH level was unrelated to the pathological changes of hyperparathyroidism in parathyroid.
出处
《中国血液净化》
2015年第12期732-735,共4页
Chinese Journal of Blood Purification
