Jin Judy, Robinson Ann V, Hallowell Peter T, Jasper John J, Stellato Thomas A, Wilhem Scott M
Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
Surgery. 2007 Dec;142(6):914-20; discussion 914-20. doi: 10.1016/j.surg.2007.09.023.
Endocrine changes, particularly increases in parathyroid hormone (PTH), occurring after gastric bypass procedures have been reported but are not well characterized.
We reviewed retrospectively patients who underwent Roux-en-Y (short limb (SL) = 75 cm, long limb (LL) = 165 cm) gastric bypass procedures at our institution from January-December 2005. Patient demographics, laboratory values of serum calcium, Vitamin D, and phosphorous concentrations as well as levels of alkaline phosphate and PTH were followed at quarterly intervals for one year.
140 patients were identified. Mean age for the group was 45 years and 90% of patients were female. The average BMI was 49.2. The mean PTH levels increased from 29.4 immediately post-op to 43.1 ng/mL (P < .001) one year after surgery. Five percent of the patients had hyperparathyroidism (PTH>53 ng/mL) immediately postoperatively; the ratio then increased to 21% at one year. Only two patients had evidence of true primary hyperparathyroidism with increased PTH and hypercalcemia. Sixty percent of patients had at least a 10 ng/mL increase in PTH level at the end of one year, reflecting a 30% increase from baseline levels. Vitamin D deficiency (levels <20 ng/mL) were identified in 45 patients (32%) initially postoperatively and they continued to be low compared to the rest of the population (P = .004). Vitamin D levels did vary with seasonal sun exposure and were greatest in the third quarter (July-September). Sub-analysis of the group showed that patients with LL gastric bypass had lesser Vitamin D concentrations (22 vs 30 ng/mL, P < .01) compared to SL patients.
Although preoperative endocrine abnormalities are present in patients undergoing gastric bypass procedures, the derangements intensify after gastric bypass surgery. A four-fold increase in patients with elevated PTH deserves special attention. When combined with the concurrent prevalence of low serum Vitamin D and normocalcemia in this population, we propose that this is a disorder of secondary hyperparathyroidism requiring medical treatment with Vitamin D supplementation.
已有报道称，胃旁路手术后会出现内分泌变化，尤其是甲状旁腺激素（PTH）升高，但目前对这些变化的特征了解尚不充分。
我们回顾性分析了2005年1月至12月在我院接受Roux-en-Y胃旁路手术（短肢（SL）=75cm，长肢（LL）=165cm）的患者。对患者的人口统计学资料、血清钙、维生素D、磷浓度的实验室值以及碱性磷酸酶和PTH水平进行为期一年的季度随访。
共纳入140例患者。该组患者的平均年龄为45岁，90%为女性。平均体重指数为49.2。术后即刻PTH平均水平为29.4，术后一年升至43.1 ng/mL（P<.001）。5%的患者术后即刻患有甲状旁腺功能亢进（PTH>53 ng/mL）；该比例在术后一年升至21%。只有两名患者有真正原发性甲状旁腺功能亢进的证据，表现为PTH升高和高钙血症。60%的患者在一年后PTH水平至少升高10 ng/mL，较基线水平升高30%。45例患者（32%）术后即刻存在维生素D缺乏（水平<20 ng/mL），与其他人群相比，其维生素D水平持续较低（P=.004）。维生素D水平随季节性阳光照射而变化，在第三季度（7月至9月）最高。对该组患者的亚组分析显示，与SL患者相比，LL胃旁路手术患者的维生素D浓度较低（22 vs 30 ng/mL，P<.01）。
尽管接受胃旁路手术的患者术前存在内分泌异常，但胃旁路手术后这些紊乱会加剧。PTH升高的患者数量增加了四倍，值得特别关注。鉴于该人群中同时存在低血清维生素D和血钙正常的情况，我们认为这是一种继发性甲状旁腺功能亢进症，需要补充维生素D进行药物治疗。
