| Objective:The aim of the study was to analyze the changes of laboratory indexes and clinical symptoms in dialysis patients with secondary hyperparathyroidism(SHPT)after parathyroidectomy(PTX).In addition,the effect of PTX on serum Pinl level was investigated.Merhods:A total of 182 dialysis patients who underwent PTX between February 2012 and January 2018 at the Second Affiliated Hospital of Suzhou University were included in this study.Preoperative and postoperative intact parathyroid hormone(iPTH)and laboratory parameters were tested.We also counted and analyzed the improvement of symptoms,as well as PTX complications and recurrence rate.In addition,26 hemodialysis patients who underwent PTX between September 2018 and December 2018 in our hospital were set as experimental group,and 26 healthy patients were set as control group.The expression level of Pin1 was measured and the subjects’ basic data and laboratory test results were collected.Results:1、The intraoperative and postoperative iPTH was significantly declined compared with preoperative data(p<0.05).The success rate of PTX was 85.2%and six-month recurrence rate was 5.5%.2、The levels of postoperative calcium,phosphorus and alkaline phosphatase also declined significantly(p<0.05).One year after surgery,the rates of serum calcium,phosphorus and iPTH reaching the recommended range of KDIGO guidelines were 68.1%,61.6%and 33.3%,respectively.3、According to the visual analogue scale,compared with that before operation,the bone pain score of the patients decreased from 5.27±1.76 to 2.93±1.45,and the skin itch score decreased from 5.43±2.03 to 3.34±1.65 one month after the surgery(p<0.05).4、It was found that the levels of iPTH,calcium,phosphorus and alkaline phosphatase could be significantly reduced by the three surgical methods(p<0.05).The success rates of S-PTX,T-PTX and PTX+AT were 70.6%,89.3%and 88.3%respectively,the recurrence rates were 7.1%,0%and 6.4%respectively,and the incidence of hypocalcemia was 47.1%,75%and 63.3%respectively one week after operation.5、The main postoperative complications were hypocalcemia.The incidence of hypocalcemia was 62.1%,50.3%,44.5%and 21.0%at 1 week,3 months,6 months and 1 year after operation.6、The Pinl level of HD-SHPT group(437.63±68.49 pg/ml)was obviously lower than that of control group(598.94±121.52 pg/ml).In experimental group,Pinl was negatively correlated with iPTH(r=-0.796,p<0.001),regardless of calcium,phosphorus,creatinine,glomerular filtration rate,gender,age.7、In experimental group,serum Pinl level significantly increased at one week after PTX(p<0.05).However,it decreased again at one year after the operation,with significant difference compared with that before the operation and one week after the operation(p<0.05).Conclusion:PTX has high success rate and can obviously reduce iPTH,calcium,phosphorus and alkaline phosphatase levels in patients with SHPT.PTX can reduce itching and bone pain in SHPT patients.Severe complications after operation were rare and recurrence rate was low.All three surgical methods can improve secondary hyperparathyroidism,and each has its own advantages.The expression level of Pinl in experimental group declined obviously compared with that in control group.Serum Pinl was negatively correlated with iPTH.PTX can promote the expression of Pinl and thus have therapeutic effect. |
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