| Objective:To investigate the relationship between bone metabolism markers and postoperative hypocalcemia in maintenance hemodialysis patients with severe secondary hyperparathyroidism.Other related factors of hypocalcemia.Methods:A total of 66 MHD patients treated with PTX+AT for SHPT in the in the North Jiangsu People's Hospital and the four districts of Yangzhou City from January 2017 to October 2018 were enrolled in this study.The baseline clinical data of the patients,the biochemical indicators and iPTH,ALP before and after PTX for 3 months were collected.The venous blood of 66 patients was collected after PTX for 3 months.After high-speed centrifugation,the upper serum was taken for ELISA to detect BALP,PINP,TRACP5 b levels.All the patients were divided into normal group(blood calcium?2.10mmol/L)and low calcium group(blood calcium <2.10 mmol/L)according to the blood calcium levels measured at 3 months after PTX.The biochemical indicators and bone metabolism markers were compared between the two groups.The effect of parathyroidectomy on calcium and phosphorus metabolism in MHD patients with secondary hyperparathyroidism.The correlation between blood calcium levels after PTX and various factors(biochemical indicators,iPTH,ALP,bone metabolic markers)were also analyzed.Results:1.Compare the effects of surgical treatment on SHPT patients.The levels of serum calcium,serum phosphorus,iPTH and ALP after PTX were significantly lower than those before PTX(P<0.05).The postoperative hemoglobin and albumin levels were higher than those before operation(P<0.05).2.There was no significant difference in gender,dialysis time and BMI between the two groups(P>0.05).The age of the normalgroup was larger compared to the low calcium group(t=2.225,P=0.03<0.05).Preoperative blood calcium levels were higher in the normal group than the low calcium group(t=7.03,P<0.001).The preoperative iPTH and preoperative ALP levels in the normal group were lower than those in the low calcium group(t=-7.003,P<0.001;t=-12.506,P<0.001).There were no significant differences in preoperative HB,preoperative ALB,preoperative P,postoperative biochemical parameters,postoperative BALP,PINP,and TRACP5 b between the two groups(P>0.05).3.Spearman method was used to analyze the correlation between postoperative blood calcium level and various factors: The postoperative blood calcium level was positively correlated with preoperative blood calcium level and age(r=0.579,P<0.001;r=0.772,P<0.001);postoperative serum calcium level was negatively correlated with preoperative iPTH and preoperative ALP levels(r=-0.646,P<0.001;r=-0.536,P<0.001);There was no significant correlation between postoperative blood calcium levels and postoperative BALP,PINP,and TRACP5 b levels(P>0.05).4.Stepwise multiple linear regression analysis showed: postoperative blood calcium levels were correlated with age,preoperative serum calcium,preoperative ALP levels(P<0.05),and the 65.8% variation of the dependent variable(postoperative blood calcium level)are explained by the above factors(corrected R2=0.658).Conclusions:1.MHD patients with severe secondary hyperparathyroidism were treated with parathyroidectomy plus forearm implantation.The calcium,phosphorus metabolism,the levels of hemoglobin and albumin were significantly improved.2.The preoperative iPTH and ALP levels are higher,the postoperative hypocalcemia was more severe,those may be the risk factor for hypocalcemia after PTX.The preoperative blood calcium levels and the patient's age may be the protection factor for postoperative hypocalcemia.3.The age,preoperative blood calcium levels and preoperative ALP levels have predictive value for postoperative blood calcium levels,but postoperative blood calcium levels is affected by many factors,such as whether the postoperative calcium supplement is timely and the dose is sufficient.Patients with persistent low calcium after PTX should follow up to monitor blood calcium levels and strengthen calcium supplementation. |
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