48例规律透析患者甲状旁腺病理形态分析及8例电镜下超微结构观察

目的 探讨继发性甲状旁腺功能亢进症（secondary hyperparathyroidism,SHPT）患者甲状旁腺组织病理形态改变与甲状旁腺激素水平、透析龄等因素的关系.方法 通过形态学观察比较,研究48例规律透析患者因SHPT切除的甲状旁腺病理学形态特征.结果 甲状旁腺激素水平与增生甲状旁腺的细胞类型无相关性,与患者性别、继发陈旧性出血及钙化程度无相关性（P＞0.05）,48例规律透析患者SHPT （95.8％,46/48）以甲状旁腺结节状增生为主,甲状旁腺继发性出血（70.8％,34/48）及钙化（62.5％,30/48）在SHPT的规律透析患者中广泛存在,透析龄的延长对钙化的程度及范围影响较大（P＜0.05）.电镜下可见增生的甲状旁腺细胞内含丰富的线粒体及核蛋白体.结论 长期规律透析患者形成SHPT时甲状旁腺内钙化灶形成及反复的出血是常见的继发性改变,结节状增生是难治性继发性甲状旁腺增生的病理形态基础.电镜下所见提示增生的甲状旁腺细胞呈高活性状态.

Pathological analysis of 48 parathyroid samples and ultra-structural observation of 8 parathyroid samples from dialysis patients with secondary hyperparathyroidism

Objective To study the pathological characteristics of parathyroid samples from dialysis pa- tients with secondary hyperparathyroidism （SHPT）, and to correlate these characteristics with parathyroid hor- mone （PTH） level and dialysis duration. Methods During the period from 2009 to 2012, 48 end-stage renal disease patients with SHPT were diagnosed and treated in China-Japan Friendship Hospital. Pathological changes of the 48 surgical parathyroid samples were analyzed with their clinical factors. Eight of the samples were examined by electron microscopy. Results The hyperplastic cell type in parathyroid samples was unre- lated to serum PTH level, gender, secondary hemorrhage and calcification （P〉0.05）. In the 48 samples, nodu- lar hyperplasia was found in 46 samples （95.8%）, secondary hemorrhage in 34 samples （70.8%）, and calcifica- tion in 30 samples （62.5%）. Calcification area and degree in samples were positively correlated with dialysis duration （P〈0.05）. Mitochondria and ribosomes increased in hyperplastic parathyroid cells by electron mi- croscopy. Conclusions Hemorrhage and/or calcification often appeared in parathyroid in dialysis patients with SHPT. The extent of calcification in parathyroid positively correlated with dialysis duration. Nodular hy- perplasia in parathyroid was the important pathologic basis for refractory SHPT in dialysis patients. Ultra- structural changes in parathyroid cells indicated the hyperactive status of parathyroid cells.