Abstract: Objective: To  evaluate  coronary  artery  calcification  in  patients  with  secondary  hyperparathyroidism （ SHPT），  analyze  its  risk  factors  and  compare  the  effects  of  parathyroidectomy （ PTX ）   on  it.       Methodology: A retrospective analysis was performed in 346  patients  who  received  PTX  in  our  hospital  due  to  severe  SHPT.  Preoperative coronary artery CTA and biochemical  examinations  of  the  patients  were  completed  for  further  statistical  analysis， so  as  to understand the  situation  of  coronary  artery  calcification  and  its  risk  factors  in  patients  with  SHPT.  The  changes  and influencing factors of coronary calcification before  and after  PTX were  compared in 31 patients 1 to 2  years  after  PTX. Results:Among the 346 patients， there were 147 female patients， with an average age of 48.54±10.30 years and a dialysis age of 100.08± 48.90  months.  A  total  of  102  patients  had  been  treated  with  calcium⁃based  phosphate  binder，  and  184 patients had been treated with active vitamin D shock therapy. Among the 346 patients， 288 cases （ 83.23%） had coronary artery calcification.  The  calcification  score ≥400  was  considered  as  the  severe  coronary  artery  calcification  group  （ 183 cases， 52.89%）， and the score < 400  was  considered  as  the  non⁃severe  coronary  artery  calcification  group  （ 163  cases， 47.11%）. In the severe coronary artery calcification group， there were more males， older age， longer dialysis age， higher preoperative iPTH， higher proportion  of  diabetes，  higher  troponin  T，  and  higher  NT⁃proBNP.  Among  all  coronary  artery calcification stenosis， the anterior  descending  branch  （ 77.1%），  right  coronary  artery  （ 65.6%）  and  circumflex  branch （ 51.5%）   were  most  commonly  involved，  with  the  proportion  of  severe  stenosis  in  the  anterior  descending  branch （ 16.2%）， right coronary artery （ 13.5%）  and  circumflex  branch  （ 7.6%）.  Binary  Logistic  regression  was  performed  for the presence OR absence of  severe  coronary  calcification， and  it  was  found  that  the  male  （ OR = 2.273，95% CI  1.425 ~ 3.628，P = 0.001）， the older the age（ OR = 1.047，95%CI 1.022~ 1.073，P<0.001）， the higher preoperative iPTH （ OR= 1.001，95%CI 1.000~ 1.001，P = 0.001）， the patients with diabetes（ OR = 5.713，95%CI 1.595~ 20.465，P = 0.007）， the more likely it was to have severe coronary calcification. Biochemical and coronary CTA indicators were re⁃examined 1 to 2 years  after  PTX.  Parathyroid  hormone，  blood  calcium，  blood  phosphorus  and  alkaline  phosphatase  were  significantly decreased compared with those before surgery， and the changes in coronary calcium score were not statistically significant. Conclusion:Coronary artery calcification exists in most SHPT patients. Male， old age， long dialysis age and high iPTH are risk factors for severe coronary artery calcification. There was no significant change in coronary artery calcification after PTX， but  high  cholesterol  and  large  dose  of  calcium  supplementation  were  the  factors  that  aggravated  coronary  artery calcification.

Key words: secondary hyperparathyroidism, coronary artery calcification,  parathyroidectomy