Clinical Study Of Different Treatment Methods For Secondary Hyperparathyroidism In Uremia

Objective:To compare the efficacy of parathyroidectomy and cinacalce in the treatment of secondary hyperparathyroidism in uremia.Methods: From June 2016 to December 2017,25 patients with secondary hyperthyroidism(i PTH > 800 pg / ml)who were admitted to Huangshan people’s Hospital from June 2016 to December 2017 were randomly divided into two groups.Two groups were randomly divided into two groups: one group was treated with parathyroidectomy and anther group was treated with medication:cinacalcet(Gepin).a retrospective cohort study was conducted in both groups.The changes of serum calcium,phosphorus metabolism,serum alkaline phosphatase(AKP)and parathyroid hormone(PTH)before and after treatment were retrospectively analyzed.Compare the changes of pruritus,bone pain,joint pain,fatigue and quality of life between the two groups before and after treatment,and the recurrence rate of treatment between the two groups was compared,according to the recorded data.Results: Among the 23 patients,total resection of parathyroid gland +autotransplantation was performed in 9 cases,the success rate of operation was 100 %,the symptoms of skin itching,bone pain and weakness of the patient were relieved after operation.Compared with the pre-operative phase,the mental,sleep quality and appetite of all patients were significantly improved.After operation,i PTH(P < 0.001,serum calcium(P < 0.001),serum phosphorus(P < 0.001)and serum alkaline phosphatase(ALP)(P < 0.001)were significantly lower than those before operation.There were 2 patients with hoarseness after operation,but all recovered to normal on one month.No serious recurrent laryngeal nerve injury occurred,but severe choking cough,asphyxia,dysphagia,infection of incision,hemorrhage and other complications occurred.The incidence of hypocalcemia was as high as 100% 9/9 after 2weeks.After central vein calcium supplementation,the blood calcium level was maintained at the ideal level without serious consequences.During the six months of follow-up,the recurrent hyperparathyroidism accounted for 11.11% of the patients with recurrent hyperparathyroidism.Fourteen patients were treated with cinacalcet(Gepin).The symptoms such as pruritus,bone pain and myasthenia were relieved in different degree after treatment.The sleep,mental state and appetite of most patients were improved compared with those before treatment.Compared with before treatment,i PTH(P < 0.001),Ca(P < 0.001),P(P < 0.001)and AKP(P < 0.001)were significantly lower after treatment.During the half year follow-up,the patients with persistent or recurrent hyperparathyroidism accounted for 57.14%(8 cases of hyperparathyroidism).There was no significant difference in sex composition,age,dialysis age and so on between the two groups.The recurrence rate in the surgical group was significantly lower than that in the drug cinacalce group,with statistical significance.Conclusion:(1)Both PTX and cinacalce can significantly improve the symptoms of SHPT patients and reduce the levels of SHPT,calcium,phosphorus,and AKP.(2)The incidence of hypocalcemia after PTX is high.After active calcium supplementation,blood calcium can be maintained at the ideal level,and there is no serious complication caused by hypocalcemia.(3)The incidence of persistent SHPT and recurrent SHPT after PTX was lower than that of cinacalcet(4)Cinacalce’s treatment of refractory SHPT was less effective than PTX,and the cost of of long-term treatment was higher.