The Effect Of Parathyroidectomy On Anemia And Cardiac Function In Uremic Patients With Secondary Hyperparathyroidism

Objective:To explore the effect of parathyroidectomy(PTX)on the anemia and cardiac function in uremic patients with secondary hyperparathyroidism(SHPT).Methods:The uremic patients who undergoing PTX in first affiliated hospital of zhejiang university from January 2010 to December 2015 were included in this study.Their general data and clinical data were collected,then all patients were followed up for 1?3 years.Paired T test and non parametric rank sum test were used to compare the changes of anemia indicators,cardiac function indicators determined by echocardiography,dry weight,calcium,phosphorus,albumin(ALb)and parathyroid hormone(PTH)before and after operation.The patients were divided into LVH group and non-LVH group,elderly group(?60 years old)and non-elderly group(<60 years old),and EF<60%group.The changes of echocardiographic parameters in each subgroup before and after operation were compared.Results:1.A total of 130 patients were followed up for 1 year,including 119 cases of hemodialysis(HD),11 cases of peritoneal dialysis(PD),78 cases of male and 52 cases of female.(1)Compared with preoperative period,iPTH,calcium and phosphorus decreased significantly 1 week,1 month,3 months and 1 year after operation(P<0.01).The serum ALb level decreased 1 week after operation,and increased 3 months,1 year after operation,the difference was statistically significant(P<0.01).(2)Compared with preoperative period,hemoglobin(Hb),hematocrit(Hct)decreased 1 week and 1 month after operation(P<0.01).The levels of Hb and Hct at 3 months and 1 year after operation were significantly higher than those before operation and 1 month after operation(P<0.01).Compared with pre-operation and 1 month after operation,erythropoietin average usage decreased significantly 3 months and 1 year after operation(P<0.01).Mann-Kendall test results indicate that the dosage of EPO showed a downward trend(P<0.05).(3)Compared with preoperative period,the cardiac function indexes(left ventricular end-diastolic diameter(LVDd),interventricular septum end-systolic thickness(IVSs),left ventricular end-systolic diameter(LVDs),left ventricular myocardial mass(LVM),left ventricular myocardial mass index(LVMI),interventricular septum end-diastolic thickness(IVSd),left ventricular posterior wall end-diastolic thickness(LVPWd))decreased significantly 1 year after operation,and dry weight increased(P<0.05 or 0.01);There was no significant difference in left ventricular ejection fraction(EF),left ventricular short axis shortening rate(FS),left atrial diameter(LA)and left ventricular posterior wall end-systolic thickness(PWS)(P>0.05).In the non-LVH group,only IVSs decreased 1 year after operation(P<0.05);In the LVH group,LVDs,LVDd,LVPWd,LVM,LVMI and IVSs decreased significantly 1 year after operation than those in preoperative period(P<0.05 or 0.01).In the elderly group,LVPWd,LA,LVM and LVMI decreased 1 year after operation(P<0.05);The levels of LVDd,LVPWd,LVDs,IVSs,LVM and LVMI in the non-elderly group at 1 year after operation were significantly lower than those before operation(P<0.05 or 0.01).EF and FS increased 1 year after operation in EF<60%group,while LVDs,LVM and LVMI decreased significantly(P<0.05 or 0.01),other indicators showed no significant difference compared with those before operation(P>0.05).2.A total of 91 patients were followed up for 2 years.Compared with preoperative period,LVDd,IVSs,LVDs,LVM and LVMI significantly decreased,EF increased 1 year after the operation(P<0.05 or 0.01);LVDd,LVPWd,IVSs,LVDs,IVSd,LVM and LVMI significantly decreased 2 years after the operation(P<0.05 or 0.01).Compared with 1 year after operation,EF and FS decreased significantly 2 years after operation(P<0.05).In non-LVH group,compared with preoperative period,only IVSs decreased 2 years after operation(P<0.05);In LVH group,compared with preoperative period,LVDs,LVDd,LVPWd,LVM and LVMI decreased 1 year after operation(P<0.05 or 0.01),LVDs,LVDd,LVPWd,IVSd,IVSs,LVM,LVMI decreased 2 years after the operation,the difference was statistically significant(P<0.05).There were 20 patients with EF<60%.Compared with pre-operation,EF and FS increased one year after operation,while LVDd and LVDs decreased(P<0.01 or 0.05).Compared with pre-operation,EF and FS increased two years after operation,while IVSd,LVDd,LVDs,LVM and LVMI decreased(P<0.01 or 0.05).Compared with one year after operation,dry weight increased two years after operation and IVSd decreased,the difference was statistically significant(P<0.01 or 0.05).3.A total of 14 patients completed the 3 years follow-up.Compared with preoperative period,LVDd,LVDs,PWs,LVM,LVMI decreased significantly 2 years after operation(P<0.01 or 0.05);LVDd,LVDs,LVM,LVMI decreased significantly 3 years after operation(P<0.01 or 0.05).Conclusions:PTX with forearm transplantation is a safe and effective treatment for uremic patients with SHPT.The reduction of calcium,phosphorus and PTH is effective and the situation of anemia is obviously improved after the operation.PTX has a good effect on improving left ventricular hypertrophy in patients,especially in patients with ventricular hypertrophy before operation,which can reduce the degree of ventricular remodeling,it can also bring significant clinical benefits to elderly patients.In addition,Patients with lower systolic function can not only successfully get through the perioperative period,but also their related echocardiographic indexes such as EF after operation are improved,PTX helps to reduce the incidence of cardiovascular events in uremic patients with SHPT.