Matsuoka Susumu, Tominaga Yoshihiro, Sato Tetsuhiko, Uno Nobuaki, Goto Norihiko, Katayama Akio, Uchida Kazuharu, Takami Hiroshi
Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
World J Surg. 2007 Apr;31(4):824-31. doi: 10.1007/s00268-006-0601-8.
In uremic patients, metabolism of 1-84 parathyroid hormone (PTH) and fragments are delayed, and in these patients, the usefulness of intraoperative PTH assay may be problematic. We evaluated the usefulness of the QuiCk-IntraOperative Bio-Intact PTH (QPTH) assay for uremic patients with secondary hyperparathyroidism who required total parathyroidectomy (PTx) with forearm autograft. The purpose of our study was to recognize whether QPTH in uremic patients was useful to determine during operation whether complete PTx had been achieved.
Forty-four patients who underwent initial PTx were enrolled in this study. Blood samples were drawn just after induction of general anesthesia (basal samples), immediately after removal of the last gland, and at 5, 10, 15, and 30 minutes, and at the first morning after PTx. The assay was performed immediately after sample collection. Reductions of PTH levels were evaluated and expressed in percentage of basal levels.
The mean PTH levels in 41 patients, excluding 3 in whom the PTH level did not drop significantly (>60 pg/ml), measured by QPTH at anesthesia, 0, 5, 10, 15, and 30 minutes were 734.3, 104.7, 58.8, 37.4, 27.0, 16.3 pg/ml, corresponding to 100%, 17.1%, 9.3%, 5.8%, 4.1%, 2.4% of the preexcision values, respectively. If the cutoff value was defined as 10.8% at 10 minutes, the sensitivity was 100% and specificity 90%. When the QPTH level dropped to under 10.8% at 10 minutes, we could consider that all glands were removed.
QPTH in uremic patients is very useful to determine whether complete PTx is achieved during operation.
在尿毒症患者中，1-84甲状旁腺激素（PTH）及其片段的代谢延迟，对于这些患者，术中PTH检测的实用性可能存在问题。我们评估了快速术中生物完整PTH（QPTH）检测对需要行甲状旁腺全切术（PTx）并进行前臂自体移植的继发性甲状旁腺功能亢进尿毒症患者的实用性。我们研究的目的是确定尿毒症患者的QPTH是否有助于在手术中判断是否已实现完全PTx。
44例行初次PTx的患者纳入本研究。在全身麻醉诱导后即刻（基础样本）、摘除最后一个腺体后即刻、术后5、10、15和30分钟以及PTx后的第一个早晨采集血样。样本采集后立即进行检测。评估PTH水平的降低情况，并以基础水平的百分比表示。
41例患者（不包括3例PTH水平未显著下降者[>60 pg/ml]）在麻醉时、术后0、5、10、15和30分钟通过QPTH检测的平均PTH水平分别为734.3、104.7、58.8、37.4、27.0、16.3 pg/ml，分别相当于切除前值的100%、17.1%、9.3%、5.8%、4.1%、2.4%。如果将10分钟时的临界值定义为10.8%，则敏感性为100%，特异性为90%。当10分钟时QPTH水平降至10.8%以下时，我们可以认为所有腺体均已摘除。
尿毒症患者的QPTH对于判断手术中是否实现完全PTx非常有用。
