Starr F L, DeCresce R, Prinz R A
Department of General Surgery, Rush-Presbyterian-St Luke's Medical Center, Chicago, IL 60612, USA.
Surgery. 2000 Dec;128(6):930-5;discussion 935-6. doi: 10.1067/msy.2000.110850.
Intraoperative intact parathyroid hormone (iPTH) is being used to confirm complete excision of hyperfunctioning parathyroid tissue. It is uncertain whether normalization of intraoperative iPTH levels accurately predicts long-term postoperative iPTH values.
Fifty-two consecutive patients with primary or secondary hyperparathyroidism underwent parathyroidectomy with measurement of intraoperative iPTH. Ten patients were excluded due to incomplete laboratory follow-up. Follow-up serum calcium and iPTH levels were measured at 1- and 3-month intervals.
Before operation, the mean serum iPTH level was 249 pg/mL (SD=208) and mean serum calcium level was 11.4 +/- 0.9 mg/dL (+/- SD). In all but 4 patients, final intraoperative iPTH levels normalized to less than 67 +/- 41 pg/mL (mean, 35 pg/mL). One week after operation, serum calcium levels had returned to normal (mean, 9.4 +/- 1.1 pg/mL), which directly correlated with the final intraoperative serum iPTH values (Pearson correlation, r = -.434; P <.01). By 1 month, all but 2 patients were normocalcemic (mean, 9.4 +/- 0.9 pg/mL) with a mean iPTH level of 74.8 +/- 82 pg/mL. There was no correlation between final intraoperative and postoperative serum iPTH values (r =.099; P <.533). Both patients with persistent hypercalcemia at 1 month had appropriate intraoperative decreases in iPTH values.
Intraoperative serum iPTH levels significantly correlate with postoperative serum calcium levels but not with postoperative serum iPTH levels. There was a 4.8% failure rate in the correction of postoperative serum calcium levels and a 29% failure rate in the normalization of postoperative serum iPTH levels.
术中完整甲状旁腺激素（iPTH）被用于确认功能亢进甲状旁腺组织的完全切除。目前尚不确定术中iPTH水平正常化是否能准确预测术后长期iPTH值。
52例连续性原发性或继发性甲状旁腺功能亢进患者接受甲状旁腺切除术并测定术中iPTH。10例患者因实验室随访不完整被排除。随访血清钙和iPTH水平每1个月和3个月测定1次。
术前，血清iPTH平均水平为249 pg/mL（标准差=208），血清钙平均水平为11.4±0.9 mg/dL（±标准差）。除4例患者外，所有患者术中最终iPTH水平均正常化至低于67±41 pg/mL（平均35 pg/mL）。术后1周，血清钙水平恢复正常（平均9.4±1.1 pg/mL），这与术中最终血清iPTH值直接相关（Pearson相关系数，r = -0.434；P <0.01）。到1个月时，除2例患者外，所有患者血钙正常（平均9.4±0.9 pg/mL），iPTH平均水平为74.8±82 pg/mL。术中最终血清iPTH值与术后血清iPTH值之间无相关性（r = 0.099；P <0.533）。1个月时持续高钙血症的2例患者术中iPTH值均有适当下降。
术中血清iPTH水平与术后血清钙水平显著相关，但与术后血清iPTH水平无关。术后血清钙水平校正失败率为4.8%，术后血清iPTH水平正常化失败率为29%。
