引用本文:程若川,苏艳军.我国外科治疗肾性继发性甲状旁腺功能亢进的适应证与风险思考[J].中国临床新医学,2019,12(3):241-246.
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我国外科治疗肾性继发性甲状旁腺功能亢进的适应证与风险思考
程若川,苏艳军
650031 云南,昆明医科大学第一附属医院甲状腺外科,云南省甲状腺外科临床研究中心
摘要:
[摘要] 继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)是慢性肾脏疾病(chronic kidney disease,CKD)的常见并发症,而甲状旁腺切除术(parathyroidectomy,PTX)是治疗SHPT的重要手段之一。在我国PTX使用率低,PTX手术适应证多采用国际指南推荐的标准,并被认为是高风险的外科治疗手段。该文主要对全段甲状旁腺激素(intact parathyroid hormone,iPTH)>800 pg/ml作为PTX适应证切点值和手术风险进行述评。在国内开展SHPT外科治疗的前瞻性随机对照研究,更低的iPTH切点值(<800 pg/ml)作为PTX适应证和在CKD早期实施PTX[而非终末期肾脏病(end stage renal disease,ESRD)],有可能给患者带来更好的获益和更低的手术风险,也更有助于制定适合我国SHPT患者的PTX适应证。组建多学科诊疗模式(multidisciplinary team,MDT)诊疗团队,有助于外科治疗SHPT的临床与研究工作的安全开展。
关键词:  慢性肾脏疾病  继发性甲状旁腺功能亢进  甲状旁腺切除术
DOI:10.3969/j.issn.1674-3806.2019.03.01
分类号:R 582+.1
基金项目:国家自然科学基金资助项目(编号:81760142)
Comments on the indication and risk of parathyroidectomy in chronic kidney disease patients with secondary hyperparathyroidism in China
CHENG Ruo-chuan, SU Yan-jun
Department of Thyroid Surgery, the First Affiliated Hospital of Kunming Medical University, Clinical Research Center of Thyroid Surgery in Yunnan Province, Yunan 650031, China
Abstract:
[Abstract] Secondary hyperparathyroidism(SHPT) is a common complication in patients with chronic kidney disease(CKD), and parathyroidectomy(PTX) is one of the most important methods for the treatment of SHPT. The use rate of PTX is low in China, and the indications for PTX adopt the international guidelines and are considered to be a high-risk surgical treatment. This article mainly reviews intact parathyroid hormone(iPTH)>800 pg/ml as the cut-off value for indication and surgical risk of PTX. The therapeutic value of whether lower iPTH cut-off value(<800 pg/ml) for PTX and performed in the early stage of CKD instead of ESRD is applicable and brings better benefits for patients and lower surgical risks to be affirmed by prospective randomized controlled study in China. Only in this way can we develop surgical indications suitable for patients with SHPT in China. Constructing multidisciplinary team(MDT) helps to improve the safety of clinical and research of surgical treatment for SHPT.
Key words:  Chronic kidney disease(CKD)  Secondary hyperparathyroidism(SHPT)  Parathyroidectomy