Silverberg S J, Shane E, Jacobs T P, Siris E, Bilezikian J P
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
N Engl J Med. 1999 Oct 21;341(17):1249-55. doi: 10.1056/NEJM199910213411701.
In the United States, most patients with primary hyperparathyroidism have few or no symptoms. The need for parathyroidectomy to treat all patients with this disorder has therefore been questioned. We studied the clinical course and development of complications for periods of up to 10 years in 121 patients with primary hyperparathyroidism, 101 (83 percent) of whom were asymptomatic. There were 30 men and 91 women (age range, 20 to 79 years). During the study, 61 patients (50 percent) underwent parathyroidectomy, and 60 patients were followed without surgery.
Parathyroidectomy in patients with or without symptoms led to normalization of serum calcium concentrations and a mean (+/-SE) increase in lumbar-spine bone mineral density of 8+/-2 percent after 1 year (P=0.005) and 12+/-3 percent after 10 years (P=0.03). Bone mineral density of the femoral neck increased 6+/-1 percent after 1 year (P=0.002) and 14+/-4 percent after 10 years (P=0.002). Bone mineral density of the radius did not change significantly. The 52 asymptomatic patients who did not undergo surgery had no change in serum calcium concentration, urinary calcium excretion, or bone mineral density. However, 14 of these 52 patients (27 percent) had progression of disease, defined as the development of at least one new indication for parathyroidectomy. All 20 patients with symptoms had kidney stones. None of the 12 who underwent parathyroidectomy had recurrent kidney stones, whereas 6 of the 8 patients who did not undergo surgery did have a recurrence.
In patients with primary hyperparathyroidism, parathyroidectomy results in the normalization of biochemical values and increased bone mineral density. Most asymptomatic patients who did not undergo surgery did not have progression of disease, but approximately one quarter of them did have some progression.
在美国，大多数原发性甲状旁腺功能亢进患者几乎没有症状。因此，对于所有患有这种疾病的患者是否都需要进行甲状旁腺切除术存在疑问。我们对121例原发性甲状旁腺功能亢进患者进行了长达10年的临床病程及并发症发生情况的研究，其中101例（83%）无症状。患者中有30名男性和91名女性（年龄范围为20至79岁）。在研究期间，61例患者（50%）接受了甲状旁腺切除术，60例患者未接受手术而进行随访。
有症状或无症状患者接受甲状旁腺切除术后，血清钙浓度恢复正常，腰椎骨矿物质密度在1年后平均（±标准误）增加8±2%（P = 0.005），10年后增加12±3%（P = 0.03）。股骨颈骨矿物质密度在1年后增加6±1%（P = 0.002），10年后增加14±4%（P = 0.002）。桡骨骨矿物质密度无显著变化。52例未接受手术的无症状患者，其血清钙浓度、尿钙排泄或骨矿物质密度均无变化。然而，这52例患者中有14例（27%）疾病进展，疾病进展定义为至少出现一项甲状旁腺切除术的新指征。所有20例有症状的患者均患有肾结石。接受甲状旁腺切除术的12例患者中无一例复发性肾结石，而未接受手术的8例患者中有6例出现复发。
对于原发性甲状旁腺功能亢进患者，甲状旁腺切除术可使生化指标恢复正常并增加骨矿物质密度。大多数未接受手术的无症状患者疾病未进展，但其中约四分之一确实有一定程度的进展。
