Garcia de la Torre N, Wass J A H, Turner H E
Department of Endocrinology, The Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Old Road, Headington OX3 7LJ, UK.
Endocr Relat Cancer. 2003 Jun;10(2):309-22. doi: 10.1677/erc.0.0100309.
In recent decades, primary hyperparathyroidism (pHPT) has changed its clinical presentation from a disease with bone and renal involvement to a frequently asymptomatic disorder detected on routine biochemistry. Nevertheless, it remains unclear whether patients with untreated mild asymptomatic hyperparathyroidism are at risk for other complications such as increased morbidity and mortality from cardiovascular diseases. There are limited data on the incidence of cardiovascular abnormalities in mild pHPT. However, pHPT has been associated with increased risk of death from cardiovascular disease, hypertension, left ventricular hypertrophy (LVH), valvular and myocardial calcifications, impaired vascular reactivity, alterations in cardiac conduction, impaired glucose metabolism, dyslipidaemia, and alterations in body composition. The nature of some of these associations is in question, because cure of pHPT does not lead to improvement of the cardiovascular disorder e.g. hypertension. In contrast, currently available data suggest that LVH, impaired glucose metabolism and dyslipidaemia may improve after surgery and that successful parathyroidectomy could decrease the excess mortality in patients with pHPT due to cardiovascular disease.
近几十年来，原发性甲状旁腺功能亢进症（pHPT）的临床表现已从一种累及骨骼和肾脏的疾病转变为一种常在常规生化检查时被发现的无症状疾病。然而，未经治疗的轻度无症状甲状旁腺功能亢进症患者是否存在其他并发症风险，如心血管疾病导致的发病率和死亡率增加，仍不明确。关于轻度pHPT中心血管异常发生率的数据有限。然而，pHPT与心血管疾病死亡风险增加、高血压、左心室肥厚（LVH）、瓣膜和心肌钙化、血管反应性受损、心脏传导改变、糖代谢受损、血脂异常以及身体成分改变有关。其中一些关联的性质存在疑问，因为治愈pHPT并不会改善心血管疾病，如高血压。相比之下，目前可得的数据表明，LVH、糖代谢受损和血脂异常在手术后可能会改善，并且成功的甲状旁腺切除术可以降低pHPT患者因心血管疾病导致的额外死亡率。
