Woodrum Derek T, Saunders Brian D, England Barry G, Burney Richard E, Doherty Gerard M, Gauger Paul G
Department of Surgery, University of Michigan, Taubman Center TC2920H, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0331, USA.
Surgery. 2004 Dec;136(6):1169-75. doi: 10.1016/j.surg.2004.06.043.
Intraoperative parathyroid hormone (IOPTH) monitoring is common during parathyroidectomy. We hypothesized that sample site (peripheral vs central vein) may impact IOPTH interpretation.
Two hundred and one patients underwent curative parathyroidectomy for single-gland disease. IOPTH was drawn peripherally (PV) in 114 patients and centrally (CV, jugular vein) in 87 patients. Decrease from baseline IOPTH and the presence of a normal value at 10 and 15 minutes were determined. The slope of IOPTH decay was calculated. These data were compared between sample sites.
Median baseline IOPTH was 268 pg/mL (CV) and 191 pg/mL (PV, P = .003). The mean IOPTH decay slopes were -0.75 (PV) and -0.76 (CV, P = NS), and the mean percent IOPTH decrease at 10 minutes was 79% PV and 80% CV (P = NS). At 10 minutes, a > or =50% drop from baseline was seen in 94% (CV) versus 97% (PV) of patients ( P = NS), resulting in a median IOPTH of 40 pg/mL (CV) versus 34 pg/mL (PV, P = .09). By 15 minutes, the central IOPTH had decreased by > or =50% of baseline in 98% of patients ( P = NS when compared to the 10-minute PV site).
IOPTH kinetics are largely the same for PV and CV sample sites, but baseline values are higher with central sampling. Consequently, CV IOPTH levels are generally higher at 10 minutes, but this discrepancy resolves by 15 minutes. The surgeon utilizing CV samples may need to extend the sampling period.
术中甲状旁腺激素（IOPTH）监测在甲状旁腺切除术中很常见。我们推测样本采集部位（外周静脉与中心静脉）可能会影响IOPTH的解读。
201例患者因单发性甲状旁腺疾病接受了根治性甲状旁腺切除术。114例患者在外周静脉（PV）采集IOPTH，87例患者在中心静脉（CV，颈静脉）采集。测定了IOPTH相对于基线的下降情况以及10分钟和15分钟时是否存在正常值。计算了IOPTH衰减的斜率。对这些数据在不同样本采集部位之间进行了比较。
基线IOPTH的中位数在中心静脉采集时为268 pg/mL，在外周静脉采集时为191 pg/mL（P = 0.003）。IOPTH衰减的平均斜率在外周静脉采集时为-0.75，在中心静脉采集时为-0.76（P = 无显著性差异），10分钟时IOPTH下降的平均百分比在外周静脉采集时为79%，在中心静脉采集时为80%（P = 无显著性差异）。10分钟时，94%（中心静脉采集）与97%（外周静脉采集）的患者IOPTH较基线下降≥50%（P = 无显著性差异），中心静脉采集时IOPTH的中位数为40 pg/mL对外周静脉采集时为34 pg/mL（P = 0.09）。到15分钟时，98%的患者中心静脉采集的IOPTH较基线下降≥50%（与10分钟时外周静脉采集部位相比P = 无显著性差异）。
外周静脉和中心静脉样本采集部位的IOPTH动力学基本相同，但中心静脉采样时基线值更高。因此，10分钟时中心静脉采集的IOPTH水平通常更高，但这种差异在15分钟时消失。使用中心静脉样本的外科医生可能需要延长采样时间。
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