[术中甲状旁腺激素测量在原发性和继发性甲状旁腺功能亢进症中的应用价值：109例患者的经验]

[Usefulness of intraoperative PTH measurement in primary and secondary hyperparathyroidism: experience with 109 patients].

作者信息

Ohe Monique Nakayama, Santos Rodrigo Oliveira, Kunii Ilda Shizue, Abrahão Márcio, Cervantes Onivaldo, Carvalho Aluízio Barbosa, Lazaretti-Castro Marise, Vieira José Gilberto H

机构信息

Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP.

出版信息

Arq Bras Endocrinol Metabol. 2006 Oct;50(5):869-75. doi: 10.1590/s0004-27302006000500007.

DOI:10.1590/s0004-27302006000500007

PMID:17160210

Abstract

INTRODUCTION

Intraoperative parathyroid hormone measurement (IO-PTH) was first described in 1988 and it's potentially useful in predicting cure after parathyroidectomy. The aim of this study was to evaluate IO-PTH decay profile and the utility of this procedure in predicting cure in primary (PHH) and secondary (SHH) hyperparathyroidism due to renal disease.

PATIENTS AND METHODS

109 patients were evaluated from 06/2000 to 12/2004. 33 had PHH and 76 SHH (52 in dialysis, 24 with renal graft). IO-PTH was measured at times 0 (before resection), 10, 20 minutes after parathyroidectomy using immunometric assay (Elecsys-PTH/Immunoassay-Roche). Time necessary to perform assay: 10 minutes.

RESULTS

HPP patients: IO-PTH average decrease 79.2% from basal levels after 10 minutes. HPS: IO-PTH average decrease 85.8% and 87.6% after 10 minutes in dialysis and renal graft patients respectively. All patients were cured, except 2 (1 PHH, 1 SHH), because of a double adenoma and ectopic (mediastinal) parathyroid respectively. Failure in IO-PTH decrease was observed in both.

CONCLUSION

IO-PTH measurement is useful in improving surgical success rates in PHH and SHH.

摘要

引言

术中甲状旁腺激素测量（IO-PTH）于1988年首次被描述，它在预测甲状旁腺切除术后的治愈情况方面可能有用。本研究的目的是评估IO-PTH衰减曲线以及该程序在预测原发性（PHH）和继发性（SHH）肾病所致甲状旁腺功能亢进症治愈情况中的效用。

患者与方法

对2000年6月至2004年12月期间的109例患者进行了评估。33例患有PHH，76例患有SHH（52例在透析，24例进行了肾移植）。使用免疫测定法（Elecsys-PTH/免疫测定 - 罗氏）在甲状旁腺切除术前（时间0）、术后10分钟和20分钟测量IO-PTH。进行测定所需时间：10分钟。

结果

原发性甲状旁腺功能亢进症（HPP）患者：术后10分钟IO-PTH平均较基础水平下降79.2%。继发性甲状旁腺功能亢进症（HPS）：透析患者和肾移植患者术后10分钟IO-PTH平均分别下降85.8%和87.6%。除2例（1例PHH，1例SHH）外所有患者均治愈，这2例分别是由于双腺瘤和异位（纵隔）甲状旁腺。这2例均观察到IO-PTH下降失败。