Ikeda Yoshifumi, Kurihara Hideko, Morita Naomi, Miyabe Rika, Takami Hiroshi
Department of Surgery, Teikyo University School of Medicine, Kaga, Tokyo, Japan.
J Surg Res. 2007 Aug;141(2):306-10. doi: 10.1016/j.jss.2006.11.025. Epub 2007 Apr 6.
The role of the quick PTH assay in surgery for secondary HPT is unclear because of overestimation of intact PTH(1-84) values due to the cross-reactivity of currently available first-generation PTH assays with non-PTH(1-84) fragments that accumulate in renal failure. In this study, we used a second-generation quick PTH immunometric assay that are claimed to detect the biologically active PTH(1-84) molecule with no cross-reactivity with PTH fragments to investigate the potential utility of the assay during parathyroidectomy for secondary HPT.
The study was performed on 18 patients (12 women, 6 men) between October 2004 and March 2005. EDTA serum samples were drawn via a peripheral venous catheter after induction of anesthesia (basal), and at 5, 10, and 30 min after excision of diseased parathyroid glands. Serum active PTH(1-84) was measured by the quick Bio-Intact PTH(1-84) assay, which is a two-site chemiluminometric assay.
At 30 min the quick Bio-PTH(1-84) level of 16 patients was under 45 pg/mL. Four parathyroid glands were removed macroscopically from 12 of the 16 patients, and three glands were removed from the other four patients. All patients were cured of their HPT. Four enlarged parathyroid glands were removed from a patient whose Bio-Intact PTH(1-84) at 30 min had not fallen below 45 pg/mL, and no other glands were found by further exploration. At the 6 mo follow-up examination, the first-generation intact PTH level of this patient was over 45 pg/mL, but several diagnostic imaging methods did not reveal any enlarged parathyroid glands. Three enlarged parathyroid glands from the other patient, and exploration led to the identification of an ectopic parathyroid gland at the carotid bifurcation.
The results of this prospective study show that quick Bio-Intact PTH(1-84) monitoring is a valuable new tool for use in the surgical treatment of secondary HPT. An intraoperative, quick Bio-Intact PTH(1-84) assay will be of value for the adequate prediction of surgical cure.
由于目前第一代甲状旁腺激素（PTH）检测方法与肾衰竭时蓄积的非PTH（1 - 84）片段存在交叉反应，导致完整PTH（1 - 84）值被高估，因此快速PTH检测在继发性甲状旁腺功能亢进（HPT）手术中的作用尚不清楚。在本研究中，我们使用了第二代快速PTH免疫测定法，据称该方法可检测具有生物活性的PTH（1 - 84）分子，且与PTH片段无交叉反应，以研究该检测方法在继发性HPT甲状旁腺切除术中的潜在应用价值。
本研究于2004年10月至2005年3月对18例患者（12例女性，6例男性）进行。在麻醉诱导后（基础值）以及切除病变甲状旁腺后5、10和30分钟，通过外周静脉导管采集乙二胺四乙酸（EDTA）血清样本。血清活性PTH（1 - 84）采用快速生物完整PTH（1 - 84）检测法进行测定，这是一种双位点化学发光检测法。
30分钟时，16例患者的快速生物PTH（1 - 84）水平低于45 pg/mL。16例患者中的12例肉眼切除了4个甲状旁腺，另外4例患者切除了3个甲状旁腺。所有患者的HPT均得到治愈。从1例30分钟时生物完整PTH（1 - 84）未降至45 pg/mL以下的患者身上切除了4个增大的甲状旁腺，进一步探查未发现其他甲状旁腺。在6个月的随访检查中，该患者的第一代完整PTH水平超过45 pg/mL，但几种诊断成像方法均未发现任何增大的甲状旁腺。从另1例患者身上切除了3个增大的甲状旁腺，探查发现颈动脉分叉处有一个异位甲状旁腺。
这项前瞻性研究的结果表明，快速生物完整PTH（1 - 84）监测是继发性HPT外科治疗中一种有价值的新工具。术中快速生物完整PTH（1 - 84）检测对于充分预测手术治愈情况具有重要价值。
