| Abstract: | 背景：對於血液透析病患而言，副甲狀腺亢進是常見問題。副甲狀腺素也被認為是心血管疾病的危險因子。此外，心血管疾病史是血液透析病患首屈一指的死亡原因。本文的目的在於評估副甲狀腺切除手術在血液透析病患對心臟功能的影響。方法：於本院自2003年至2007年，有十五名長期血液透析病患，因患嚴重無法以藥物控制的副甲狀腺亢進，而接受副甲狀腺切除手術。本文以心臟超音波評估手術對於心臟功能影響，並以回溯性的資料蒐集，來分析手術前後臨床及生化指標變化程度。結果：左心室排出率(left ventricular ejection fraction)在副甲狀腺切除手術後明顯增加(56% vs. 62%, p=0.005)。手術前的排出率數值與排出率增加幅度呈負相關性。較低排出率組(EF≦51%)病人比較高排出率組(EF≧55%)病人更能增進術後的左心室排出率。血清鈣值(10.20 vs. 8.9 mg/dL, p<0.001)、磷值(6.0 vs. 4.1 mg/dL, p=0.043)、鈣磷乘積值(63.3 vs. 36.7 mg^2/dL^2, p≦0.013)、鹼性磷酸陌值(l17.9 vs. 62U/L, p=0.015)、及血色素值(31.8 vs. 321%, p≦0.041)在手術前後都有明顯改變。結論：在血液透析病患中，以心臟超音波評估心臟功能，發現副甲狀腺切除手術後左心室排出率增加，以及部分生化和透析指標明顯進步。
Background: In hemodialysis patients parathyroid hormone is considered a risk factor of cardiovascular disease. Moreover, cardiovascular disease is the leading cause of mortality in hemodialysis patients. The aim of this study was to assess the effect of parathyroidectomy on cardiac performance in hemodialysis patients. Methods: This is a single hospital retrospective analysis on fifteen hemodialysis patients with severe, uncontrolled secondary hyperparathyroidism undergoing parathyroidectomy between 2003 and 2007. Echocardiographic evaluation was performed before and after surgical treatment. Their clinical and biochemical parameters before and after parathyroidectomy were compared. Results: The left ventricular ejection fraction (LVEF) increased significantly after parathyroidectomy (56% vs. 62%, p=0.005). The pre-operative LVEF value had negative correlation with increment of LVEF. A significant improvement in LVEF after operation was found in the low EF group (LVEF?51%), whereas not in the high EF group (LVEF?55%), There were significant differences before and after parathyroidectomy in serum values of total calcium (10.2 vs. 8.9 mg/dL, p<0.001), phosphate (6.0 vs. 4.1 mg/dL, p=0.043), Ca×P product (63.3 vs. 36.7 mg^2/dL^2, p=0.013), alkaline phosphatase (117.9 vs. 62 U/L. p=0.015), hematocrit (31.8 vs. 32.1%, p=0.041). Conclusion: There was a significant improvement in LVEF after parathyroidectomy by echocardiographic evaluation in hemodialysis patients with hyperparathyroidism especially with impaired LV function. The serum values of total calcium, phosphate, Ca×P product and hematocrit also became better after surgical treatment. |
