摘要
目的探讨肾移植前后矿物质和骨代谢的变化及术前不同甲状旁腺激素（PTH）水平对术后矿物质和骨代谢的影响。方法回顾性分析2011年1月至2015年1月肾移植术前全段甲状旁腺激素（iPTH）〉300pg／ml、术后肾功能正常的82例受者的资料，将iPTH≥800pg／ml的26例受者作为极高PTH组，iPTH在301～799pg／ml之间的56例受者作为高PTH组，分析两组肾移植术前、术后1个月、4个月、1年、2年、3年的血清总钙、血清无机磷、iPTH、25-（羟基）维生素D3（25-OHD）、血清碱性磷酸酶（ALP）、β-胶原降解产物（β-CTX）、骨钙素N端中分子片断（N-MID）等指标的变化。结果两组受者术后血清总钙水平均呈逐渐上升趋势，至术后1个月恢复至正常参考范围，术后4个月达到平台；极高PTH组较高PTH组远期高钙血症发生率明显增高，差异有统计学意义（P〈0.05）。两组受者术后血清无机磷水平均呈逐渐下降趋势，术后1个月恢复至正常参考范围，极高PTH组术后4个月达到平台，高PTH组术后1个月达到平台；极高PTH组较高PTH组远期低磷血症发生率明显增高，差异有统计学意义（P〈0.05）。两组受者术后iPTH、ALP、β-CTX及N-MID水平均呈下降趋势，尤其在术后1个月下降明显；极高阿H组术后各时间点iPTH、ALP、β-CTX及N-MID水平均高于高PTH组，尤其术后早期的差异有显著统计学意义（P〈0．01），且极高PTH组iPTH和β-CTX的异常可持续至术后远期。两组受者25-OHD水平术后4个月达到平台，但均未达到正常参考范围，各时间点组间比较差异均无统计学意义（P〉0.05）。结论肾移植术后矿物质和骨代谢紊乱可持续存在，持续性甲状旁腺功能亢进症（HPT）在术后矿物质及骨代谢中起着重要作用；术前有重度HPT的受者HPT可延续到术后远期，并增加术后远期高钙血症和低磷血症发生率，且更易发生高的骨转化率，这种差异可延续到术后远期。
Objective To explore the changes of mineral and bone metabolism before and after renal transplantation as well as the effect of preoperative parathyroid hormone （PTH） level on postoperative mineral and bone metabolism. Methods In this retrospective analysis, we recruited 82 cases of renal transplant recipients with normal renal function and receiving kidney transplantation in our hospital from January 2011 to January 2015. All of these patients had intact PTH （iPTH） level 300 pg/mL. We chose 26 cases of recipients whose preoperative iPTH was more than or equal to 800 pg/mL as very high PTH group, and 56 cases of recipients whose preoperative iPTH was between 301- 799 pg/mL as high PTH group. We monitored and performed analysis of the total serum calcium （Ca）, serum inorganic phosphorus （P）, 25-（hydroxyl） vitamin D3 （ 25 OHD）, serum alkaline phosphatase （ALP）,Beta C-terminal telopeptide （β-CTX）,N-terminal/midregion （N-MD） pre- and 1 month, 4 months, 1 year, 2 years, 3 years post-kidney transplantation. Results Serum total calcium in the two groups was gradually increased, returned to normal range 1 month post-transplantation and reached the plateau 4 months post-transplantation. The incidence of hypercalcemia in very high PTH group was statistically significantly higher than in high PTH group. Serum phosphorus in the two groups showed a trend of gradual decline after renal transplantation, and returned to the normal range 1 month post-transplantation. The serum phosphorus level in very high PTH group reached the plateau 4 months post-transplantation, and that in high PTH group 1 month post-transplantation. Compared with high PTH group, very high PTH group has greater The incidence of long-term hypophosphatemia after renal transplantation was significantly higher in very high PTH group then in high PTH group. iPTH, ALP, β-CTX and N-MID in the two groups showed a downward trend after renal transplantation. At first month post-transplantation, iPTH, ALP, β-CTX and N-MID levels were reduced most significantly. The average levels of the three mentioned indicators in very high PTH group were higher than in high PTH group at every time point after surgery with the difference being significant during the early post-transplantation period. The anomalies of iPTH and β-CTX levels persisted to long term after transplantation in very high PTH group. 25-OHD levels in these two groups showed rising trend after renal transplantation, reached the plateau 4 months post- transplantation,but failed to achieve the ideal reference level, and no significant difference was found between two groups at any time point monitored. Conclusion The anomalies of mineral and bone metabolism after renal transplantation could persist a long time. Conclusion hyperparathyroidism in the renal transplantation plays an important role in mineral and bone metabolism. Preoperative severe HPT could continue to post-transplantation period and increase the incidence of hyperphosphatemia and hypocalcemia long term after transplantation, which may aggravate bone turnover and this effect can last a long time after transplantation.
出处
《中华器官移植杂志》
CAS
CSCD
2016年第11期647-652,共6页
Chinese Journal of Organ Transplantation
关键词
肾移植
矿物质代谢
骨代谢
甲状旁腺激素
Kidney transplantation
Mineral metabolism
Bone metabolism
Parathyroid hormone
