Libutti S K, Alexander H R, Bartlett D L, Sampson M L, Ruddel M E, Skarulis M, Marx S J, Spiegel A M, Simmonds W, Remaley A T
National Institutes of Health, Bethesda, Md. 20892, USA.
Surgery. 1999 Dec;126(6):1145-50; discussion 1150-1. doi: 10.1067/msy.2099.101835.
Rapid intraoperative parathyroid hormone (RI-PTH) assay is used to guide adequacy of resection during operation for hyperparathyroidism. We compared the RI-PTH assay (15 minutes) with a standard PTH assay, determined whether the PTH half-life varied between patients, and constructed a kinetic analysis of the RI-PTH data.
Forty-five patients with hyperparathyroidism had blood sampled at baseline and at times after parathyroid resection. Intact PTH was determined using RI-PTH and a standard assay. Values were fitted to an exponential decay curve using the baseline and the follow-up time points. PTH half-life and the new postexcision baseline value were calculated from the decay curve.
The RI-PTH assay and the standard PTH assay correlated well. Average PTH half-life was 1.68 +/- 0.94 minutes (0.42 to 3.81 minutes). A kinetic analysis yielded a formula for the generation of a PTH decay curve. Using a 50% reduction in RI-PTH at 5 minutes as the criterion for adequate resection, 2 patients were incorrectly classified as not being cured. These patients were correctly classified using the kinetic analysis.
PTH half-life can vary substantially. A kinetic analysis may be more accurate in assessing adequacy of resection. This method allows the surgeon to interpret RI-PTH data independent of the timing of samples.
术中快速甲状旁腺激素（RI-PTH）检测用于指导甲状旁腺功能亢进手术切除的充分性。我们比较了RI-PTH检测（15分钟）和标准甲状旁腺激素检测，确定了患者之间甲状旁腺激素半衰期是否存在差异，并构建了RI-PTH数据的动力学分析。
45例甲状旁腺功能亢进患者在甲状旁腺切除术前及术后不同时间点采血。使用RI-PTH检测和标准检测方法测定完整甲状旁腺激素。利用基线和随访时间点将数值拟合为指数衰减曲线。从衰减曲线计算甲状旁腺激素半衰期和新的切除后基线值。
RI-PTH检测与标准甲状旁腺激素检测相关性良好。甲状旁腺激素平均半衰期为1.68±0.94分钟（0.42至3.81分钟）。动力学分析得出了生成甲状旁腺激素衰减曲线的公式。以5分钟时RI-PTH降低50%作为切除充分的标准，2例患者被错误分类为未治愈。使用动力学分析对这些患者进行了正确分类。
甲状旁腺激素半衰期可能有很大差异。动力学分析在评估切除充分性方面可能更准确。该方法使外科医生能够独立于样本采集时间来解释RI-PTH数据。
