Gianotti Laura, Tassone Francesco, Cesario Flora, Pia Anna, Razzore Paola, Magro Giampaolo, Piovesan Alessandro, Borretta Giorgio
Division of Endocrinology and Metabolism, Department of Internal Medicine, S. Croce and Carle Hospital, Via M. Coppino 26, 12100 Cuneo, Italy.
J Clin Endocrinol Metab. 2006 Aug;91(8):3011-6. doi: 10.1210/jc.2006-0070. Epub 2006 May 30.
The impairment of renal function can affect the clinical presentation of primary hyperparathyroidism (PHPT), increasing cardiovascular morbidity, fracture rate, and the risk of mortality.
The aim of the study was to assess the differences in bone status in a series of consecutive patients affected by PHPT without overt renal failure at diagnosis grouped according to creatinine clearance (Ccr).
A total of 161 consecutive patients with PHPT were studied. They were divided into two groups based on Ccr. Group A had Ccr 70 ml/min or less (n = 49), and group B had Ccr greater than 70 ml/min (n = 112). PTH, total and ionized serum calcium; urinary calcium and phosphate; serum 25-hydroxyvitamin D3; serum and urinary bone markers; lumbar, forearm, and femoral bone mineral density (BMD) were evaluated.
Patients in group A were older than those in group B (P < 0.0001). PTH levels did not differ in the two groups, whereas both urinary calcium and phosphorus were lower in group A than group B (P < 0.01). Lower BMD was evident in group A at lumbar spine (P < 0.002), forearm (P < 0.0001), and femur (P < 0.01). In asymptomatic PHPT, those with Ccr 70 ml/min or less had lower forearm BMD than patients with higher Ccr (P < 0.00001). When adjusting for age and body mass index in PHPT, BMD at each site persisted being lower (P < 0.05) in group A than group B. In all PHPT subjects, Ccr (beta = 0.29, P < 0.0005), age (beta = -0.27, P < 0.00001), and PTH levels (beta = -0.27, P < 0.0005) were all independently associated with forearm BMD.
In PHPT a slight decrease in renal function is associated with more severe BMD decrease, independent of age, body mass index, and PTH levels. This association is also present in asymptomatic PHPT and strengthens the National Institutes of Health recommendations for surgery in patients with mild PHPT.
肾功能损害可影响原发性甲状旁腺功能亢进症（PHPT）的临床表现，增加心血管疾病发病率、骨折率及死亡风险。
本研究旨在评估一系列确诊时无明显肾衰竭的连续性PHPT患者，根据肌酐清除率（Ccr）分组后骨状态的差异。
共研究了161例连续性PHPT患者。根据Ccr将他们分为两组。A组Ccr为70 ml/min或更低（n = 49），B组Ccr大于70 ml/min（n = 112）。评估了甲状旁腺激素（PTH）、血清总钙和离子钙；尿钙和磷；血清25-羟维生素D3；血清和尿骨标志物；腰椎、前臂和股骨骨密度（BMD）。
A组患者比B组患者年龄更大（P < 0.0001）。两组的PTH水平无差异，而A组的尿钙和磷均低于B组（P < 0.01）。A组在腰椎（P < 0.002）、前臂（P < 0.0001）和股骨（P < 0.01）的BMD明显更低。在无症状PHPT患者中，Ccr为70 ml/min或更低者的前臂BMD低于Ccr较高者（P < 0.00001）。在对PHPT患者的年龄和体重指数进行校正后，A组各部位的BMD仍低于B组（P < 0.05）。在所有PHPT受试者中，Ccr（β = 0.29，P < 0.0005）、年龄（β = -0.27，P < 0.00001）和PTH水平（β = -0.27，P < 0.0005）均与前臂BMD独立相关。
在PHPT中，肾功能的轻微下降与更严重的BMD下降相关，独立于年龄、体重指数和PTH水平。这种关联在无症状PHPT中也存在，并强化了美国国立卫生研究院对轻度PHPT患者手术治疗的建议。
