| Objective To investigate the pathological features of parathyroid glands in patients with secondary hyperparathyroidism(SHPT)and the related risk factors affecting cognitive function in SHPT patients,and to determine the correlation between the types of parathyroid hyperplasia and cognitive function.Methods Forty-three patients with SHPT who underwent parathyroidectomy(PTX)were enrolled from May 2015 to December 2015 in the Department of Nephrology of Second Affiliated Hospital of Anhui Medical University.The cognitive function of all patients was assessed by MMSE and Mo CA,and the serological parameters were collected before operation.After operation,the parathyroid glands were removed and made into slide specimens.The pathological characteristics of all parathyroid glands were observed under the microscope.The cells of hyperplasia of parathyroid gland were classified and the type of hyperplasia of parathyroid gland was defined.The patients were divided into diffuse hyperplasia(DH)group and nodular hyperplasia(NH)group according to the type of parathyroid hyperplasia.The differences of serological parameters and cognitive scale scores between the two groups were compared.The general clinical data,serological indicators and cognitive scale scores were analyzed by single factor analysis to determine the related risk factors.The risk factors were introduced into the regression equation to determine the independent risk factors of cognitive impairment in SHPT patients,and to clarify the correlation between the types of parathyroid hyperplasia and cognitive changes.Results(1)The main cells(40/40)were observed in parathyroid tissue under microscope.The percentage of adipocytes and eosinophils was 80.0%(32/40)and 65%(26/40)respectively,and water-like cells were the least,accounting for only 27.5%(11/40).The morphological comparison of parathyroid glands between the two groups showed that the number of eosinophils and calcifications in parathyroid tissues in NH group was significantly higher than that in DH group(P < 0.05).(2)The results of comparison of MMSE scores between the two groups showed that the orientation score,memory score and MMSE total score in NH group were significantly lower than those in DH group(P < 0.05).The results of Mo CA scores between the two groups showed that the executive ability score,naming score,orientation score and total Mo CA score in NH group were significantly lower than those in DH group(P < 0.05).(3)Preoperative comparison of common serum indicators between the two groups showed that the levels of serum i PTH and serum calcium in NH group were higher than those in DH group,and the difference was statistically significant(P < 0.05).There was no significant difference in serum 25-hydroxyvitamin D,phosphorus and creatinine between the two groups(P > 0.05).(4)Pearson correlation analysis showed that serum total parathyroid hormone(i PTH)levels were negatively correlated with total scores of MMSE and Mo CA.Serum calcium level was negatively correlated with total scores of MMSE,and education years were positively correlated with total scores of MMSE and Mo CA.(5)Multiple linear regression analysis showed that the higher the level of serum i PTH,the lower the educational years and the lower the cognitive function score of patients with pathological type NH.Conclusions Eosinophilic and calcified lesions are common secondary changes in hyperplasia of parathyroid glands in SHPT patients.The cognitive function of NH patients is generally lower than that of DH patients.Serum levels of i PTH,serum calcium,education years and types of parathyroid hyperplasia in renal SHPT patients are closely related to cognitive function.Serum levels of i PTH,years of education and types of parathyroid hyperplasia were independent risk factors. |
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