甲状旁腺手术前后原发性甲状旁腺功能亢进症患者发生肾结石事件的风险：对照性回顾性随访研究
Risk of renal stone events in primary hyperparathyroidism before and after parathyroid surgery: controlled retrospective follow up study.
作者信息
Mollerup Charlotte L, Vestergaard Peter, Frøkjaer Vibe Gedsø, Mosekilde Leif, Christiansen Peer, Blichert-Toft Mogens
机构信息
Department of Endocrine and Breast Surgery, Copenhagen University Hospital, Rigshospitalet, DK 2100 Copenhagen, Denmark.
出版信息
BMJ. 2002 Oct 12;325(7368):807. doi: 10.1136/bmj.325.7368.807.
AIM
To study the risk of renal stone episodes and risk factors for renal stones in primary hyperparathyroidism before and after surgery.
DESIGN
Register based, controlled retrospective follow up study.
SETTING
Tertiary hospitals in Denmark.
PARTICIPANTS
674 consecutive patients with surgically verified primary hyperparathyroidism. Each patient was compared with three age- and sex-matched controls randomly drawn from the background population. Hospital admissions for renal stone disease were compared between patients and controls. Risk factors for renal stones among patients were assessed.
MAIN OUTCOME MEASURES
Number of renal stone episodes; comparison of hospital admissions for renal stones in patients and controls; assessment of risk factors for renal stones.
RESULTS
Relative risk of a stone episode was 40 (95% confidence interval 31 to 53) before surgery and 16 (12 to 23) after surgery. Risk was increased 10 years before surgery, and became normal more than 10 years after surgery. Stone-free survival 20 years after surgery was 90.4% in patients and 98.7% in controls (risk difference 8.3%, 4.8% to 11.7%). Patients with preoperative stones had 27 times the risk of postoperative stone incidents than controls. Before surgery, males had more stone episodes than females and younger patients had more stone episodes than older patients. Neither parathyroid pathology, weight of removed tissue, plasma calcium levels, nor skeletal pathology (fractures) influenced the risk of renal stones. After surgery, younger age, preoperative stones and ureteral strictures were significant risk factors for stones.
CONCLUSIONS
The risk of renal stones is increased in primary hyperparathyroidism and decreases after surgery. The risk profile is normal 10 years after surgery. Preoperative stone events increase the risk of postoperative stones. Stone formers and non-stone formers had the same risk of skeletal complications.
目的
研究手术前后原发性甲状旁腺功能亢进症患者肾结石发作的风险及肾结石的危险因素。
设计
基于登记的对照性回顾性随访研究。
地点
丹麦的三级医院。
参与者
674例经手术证实的原发性甲状旁腺功能亢进症患者。将每位患者与从背景人群中随机抽取的三名年龄和性别匹配的对照进行比较。比较患者和对照之间因肾结石疾病的住院情况。评估患者中肾结石的危险因素。
主要观察指标
肾结石发作次数；患者和对照因肾结石住院情况的比较；肾结石危险因素的评估。
结果
术前结石发作的相对风险为40（95%置信区间31至53），术后为16（12至23）。术前10年风险增加，术后10年以上恢复正常。术后20年患者的无结石生存率为90.4%，对照为98.7%（风险差异8.3%，4.8%至11.7%）。术前有结石的患者术后结石事件的风险是对照的27倍。术前，男性的结石发作次数多于女性，年轻患者的结石发作次数多于老年患者。甲状旁腺病理、切除组织重量、血浆钙水平或骨骼病理（骨折）均不影响肾结石风险。术后，年龄较小、术前有结石和输尿管狭窄是结石的重要危险因素。
结论
原发性甲状旁腺功能亢进症患者肾结石风险增加，术后降低。术后10年风险状况恢复正常。术前结石事件会增加术后结石的风险。结石形成者和非结石形成者发生骨骼并发症的风险相同。
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