Steiniche T, Christiansen P, Vesterby A, Ullerup R, Hessov I, Mosekilde L E, Melsen F
University Institute of Pathology, Aarhus Kommunehospital, Aarhus, Denmark.
Bone. 2000 May;26(5):535-43. doi: 10.1016/S8756-3282(00)00260-X.
In 19 patients with primary hyperparathyroidism (PHPT) (14 women and 5 men; age 53 +/- 11 years, range 29-69 years), bone densitometry, biochemical markers of bone turnover, and iliac crest bone biopsies were obtained before and 3 years after successful surgical treatment. A significant increase in bone mineral content (BMC) was observed in both the lumbar spine (p < 0.001) and the proximal part of the distal forearm (p < 0.001), whereas the increase in BMC in the femoral neck was insignificant. Biochemical markers of bone formation (serum alkaline phosphatase, serum bone alkaline phosphatase and serum osteocalcin) and resorption (serum pyridinoline cross-linked telopeptide of type I collagen and urine N-telopeptide of type I collagen) all decreased following treatment. In cortical bone, relative cortical width increased following surgery (p < 0.05) and cortical porosity decreased (p < 0.01). No changes were observed in core width or cortical width. In cancellous bone, no significant changes were observed in any of the measured structural parameters. However, significant reductions in the extent of osteoid- (p < 0.01) and tetracycline-labeled surfaces (p < 0.001), and in bone formation rate (p < 0.001) and activation frequency (p < 0.001), were found. The numerical decrease in the extent of eroded surfaces did not reach significance (p = 0.057). No changes were observed in mineral appositional rate and adjusted appositional rate. The amount of bone resorbed (expressed as the resorption depth) and the amount of bone reformed (expressed as wall thickness) per remodeling cycle seemed unaffected by the treatment. Consequently, no effect on bone balance per remodeling cycle could be detected. The present study of PHPT patients showed that, within 3 years after surgery, BMC of both cancellous and cortical bone areas had increased. At the same time, bone turnover decreased markedly, as judged from biochemical as well as histomorphometric data, but no changes were seen in trabecular bone structure. In cortical bone, the relative cortical width increased and the cortical porosity decreased.
对19例原发性甲状旁腺功能亢进症（PHPT）患者（14例女性，5例男性；年龄53±11岁，范围29 - 69岁），在成功手术治疗前及治疗后3年进行了骨密度测定、骨转换生化标志物检测以及髂嵴骨活检。腰椎（p < 0.001）和远端前臂近端（p < 0.001）的骨矿物质含量（BMC）均显著增加，而股骨颈BMC的增加不显著。治疗后，骨形成生化标志物（血清碱性磷酸酶、血清骨碱性磷酸酶和血清骨钙素）和骨吸收标志物（血清I型胶原吡啶交联终肽和尿I型胶原N - 端肽）均下降。在皮质骨中，术后相对皮质宽度增加（p < 0.05），皮质孔隙率降低（p < 0.01）。髓腔宽度或皮质宽度无变化。在松质骨中，所测任何结构参数均无显著变化。然而，类骨质表面（p < 0.01）和四环素标记表面（p < 0.001）的范围、骨形成率（p < 0.001）和激活频率（p < 0.001）均显著降低。侵蚀表面范围的数值下降未达显著水平（p = 0.057）。矿物质沉积率和调整后沉积率无变化。每个重塑周期吸收的骨量（以吸收深度表示）和形成的骨量（以壁厚度表示）似乎不受治疗影响。因此，未检测到对每个重塑周期骨平衡的影响。本项对PHPT患者的研究表明，术后3年内，松质骨和皮质骨区域的BMC均增加。同时，从生化及组织形态计量学数据判断，骨转换明显降低，但小梁骨结构未见变化。在皮质骨中，相对皮质宽度增加，皮质孔隙率降低。
