目的评价甲状旁腺全切除+部分前臂自体移植术(PTX+FAT)对伴有重度继发性甲状旁腺功能亢进(SHPT)的维持性透析患者肾性贫血的影响。方法取复旦大学华山医院2001～2005年22例伴有重度SHPT的维持性血液透析患者,其中PTX组11例,非PTX组11例。观察术前、术后第3、6、12个月时患者的iPTH、贫血、铁代谢、营养、透析充分性指标,同时记录患者促红细胞生成素用量、干体重、超滤量等数据。结果PTX组患者术后血清iPTH迅速下降,从第3个月起差异有显著统计学意义(P<0.01);贫血逐步改善,至术后第12个月时血红蛋白和红细胞压积较术前显著升高(P<0.01及P<0.05),与非PTX组相比差异有显著性意义(P<0.05),同时患者促红细胞生成素用量自第6个月起较术前明显减少,与非PTX组比较差异有统计学意义(P均<0.01);血清铁及转铁蛋白饱和度在术后12个月时较术前明显升高(P<0.01);前白蛋白水平自术后第6个月时也明显升高(P<0.01)。与非PTX组相比铁蛋白、C反应蛋白、透析充分性等指标差异无统计学意义(P>0.05)。结论重度SHPT血液透析患者在PTX+FAT术后可迅速降低iPTH水平并显著改善肾性贫血、减少促红细胞生成素用量,其作用可能部分与功能性缺铁及营养状况改善有关。 Objective To evaluate the effect of total parathyroidectomy + partial forearm autotransplantation (PTX + FAT) on renal anemia in maintenance hemodialysis patients with severe secondary hyperparathyroidism (SHPT). Methods 22 cases of maintenance hemodialysis patients with severe SHPT were recruited from Huashan Hospital of Fudan University from 2001 to 2005, including 11 patients in PTX group and 11 patients in non-PTX group. The patients’ iPTH, anemia, iron metabolism, nutrition and dialysis adequacy index were observed before operation and at the 3rd, 6th and 12th month after surgery. The data of erythropoietin dosage, dry weight and ultrafiltration volume were also recorded. Results The serum iPTH of patients in PTX group decreased rapidly from the third month (P <0.01), and the anemia gradually improved. The hemoglobin and hematocrit at the 12th month after operation were significantly higher than those before operation (P <0.01 and P <0.05). Compared with the non-PTX group, the difference was significant (P <0.05). At the same time, the dosage of erythropoietin was significantly decreased from the 6th month, (P <0.01); serum iron and transferrin saturation increased significantly at 12 months after operation (P <0.01); prealbumin level decreased from 6 months also significantly higher (P <0.01). Compared with non-PTX group, ferritin, C-reactive protein, adequacy of dialysis and other indicators were not statistically different (P> 0.05). Conclusions Severe SHPT hemodialysis patients can rapidly decrease iPTH level and significantly improve renal anemia and reduce the dosage of erythropoietin after PTX + FAT, which may partly be related to functional iron deficiency and improvement of nutritional status.