Yamashita Hiroyuki, Gao Ping, Cantor Tom, Noguchi Shiro, Uchino Shinya, Watanabe Shin, Ogawa Takahiro, Kawamoto Hitoshi, Fukagawa Masafumi
Noguchi Thyroid Clinic and Hospital Foundation, Beppu Oita, Japan.
Surgery. 2004 Feb;135(2):149-56. doi: 10.1016/s0039-6060(03)00387-8.
Most commercial intact parathyroid hormone (intact PTH) assays cross-react with non-(1-84) PTH (likely 7-84 PTH). Using a whole-molecule PTH (whole PTH) assay that specifically measured only 1-84 PTH, we compared the kinetics of whole PTH and intact PTH after parathyroidectomy in patients with primary hyperparathyroidism (HPT) and secondary HPT.
This study comprised 74 patients with primary HPT caused by a single adenoma and 18 patients with secondary HPT who underwent parathyroidectomy. Blood samples were drawn after anesthesia, just before excision of a single adenoma in primary HPT, and just before excision of the last parathyroid gland in secondary HPT, and at 5, 10, and 15 minutes after excision. The 7-84 PTH level was calculated by subtracting the whole PTH value from the intact PTH value.
There was a difference between the percentage of 7-84 PTH/intact PTH in plasma samples from patients with primary HPT and secondary HPT (28%+/-12% vs 35%+/-9%; P<.05). Plasma whole PTH decreased more rapidly than intact PTH after parathyroidectomy in patients in both the primary HPT (P<.0001) and secondary HPT groups (P<.0001). Decline of intact PTH was slower in patients with secondary HPT than in patients with primary HPT; however, there was no significant difference in the decline of whole PTH between the 2 groups.
The quick intact PTH assay is not used frequently during surgery in patients with secondary HPT; however, our results suggest that a quick whole PTH assay may be a more useful adjunct to parathyroidectomy in both secondary HPT and primary HPT.
大多数商业化的完整甲状旁腺激素（完整PTH）检测方法会与非（1-84）PTH（可能是7-84 PTH）发生交叉反应。我们使用一种仅特异性检测1-84 PTH的全分子PTH（全PTH）检测方法，比较了原发性甲状旁腺功能亢进症（HPT）和继发性HPT患者甲状旁腺切除术后全PTH和完整PTH的动力学变化。
本研究纳入了74例因单个腺瘤导致原发性HPT的患者和18例接受甲状旁腺切除术的继发性HPT患者。在麻醉后、原发性HPT患者切除单个腺瘤前、继发性HPT患者切除最后一个甲状旁腺前以及切除后5、10和15分钟采集血样。通过从完整PTH值中减去全PTH值来计算7-84 PTH水平。
原发性HPT患者和继发性HPT患者血浆样本中7-84 PTH/完整PTH的百分比存在差异（28%±12%对35%±9%；P<0.05）。在原发性HPT组（P<0.0001）和继发性HPT组（P<0.0001）中，甲状旁腺切除术后血浆全PTH下降速度比完整PTH更快。继发性HPT患者完整PTH的下降比原发性HPT患者更慢；然而，两组间全PTH的下降没有显著差异。结论：继发性HPT患者手术期间不常使用快速完整PTH检测；然而，我们的结果表明，快速全PTH检测可能是继发性HPT和原发性HPT甲状旁腺切除术中更有用的辅助手段。
