Erem C, Kocak M, Hacihasanoglu A, Yilmaz M, Saglam F, Ersoz H O
Division of Endocrinology and Metabolism, Department of Internal Medicine, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey.
Exp Clin Endocrinol Diabetes. 2008 Nov;116(10):619-24. doi: 10.1055/s-2008-1065365. Epub 2008 May 16.
Primary hyperparathyroidism (PHPT) is associated with an increased cardiovascular mortality and morbidity rate. However, the exact role of PTH and/or calcium in the development of cardiovascular disease (CVD) is still controversial. The influence of PHPT on hemostasis is yet unknown. Therefore, the main purpose of this study was to investigate the markers of endogenous coagulation/fibrinolysis and to evaluate the relationships between these hemostatic parameters, serum lipid profile and serum calcium and PTH in patients with PHPT.
Twenty-three patients with PHPT and 20 age-matched healthy controls were included in the study. Fibrinogen, factors V, VII, VIII, IX and X activities, von Willebrand factor (vWF), antithrombin III (AT III), protein C, protein S, tissue plasminogen activator (t-PA) and tissue plasminogen activator inhibitor-1 (PAI-1), as well as common lipoprotein variables, were measured. The relationships between biochemical parameters and these hemostatic parameters were examinated.
Compared with the control subjects, platelet count, FVII, FX activities, and D-Dimer levels were significantly increased in patients with PHPT (p<0.001, p<0.05, p<0.001, and p<0.05, respectively). Among the lipids, the levels of TC, TG and LDL-C were significantly increased in patients with PHPT (p<0.01, p<0.001, p<0.001, respectively) than those in controls. In patients with PHPT, we showed a positive correlation between urinary phosphorus excretion and factors VIII, IX, and X (r: 0.572, p<0.01; r: 0.543, p<0.01; r: 0.532, p<0.01, respectively). F IX activity was positively correlated with TC (r: 0.463, p<0.05) and LDL-C (r: 0.549, p<0.01) There was a positive correlation between serum ALP and PAI-1 levels (r: 0.451, p<0.05). ApoB was positively correlated with D-Dimer (r: 0.421, p<0.05). We did not find any significant correlation between iPTH and serum calcium and the hemostatic parameters that we measured.
In conclusion, we found some important differences in the hemostatic parameters between the patients with PHPT and healthy controls. Increased platelet count, F VII and FX activities and D-Dimer levels in patients with PHPT represent a potential hypercoagulable state, which might augment the risk for atherosclerotic and atherothrombotic complications. This condition may contribute to the excess mortality rate due to CVD in patients with PHPT.
原发性甲状旁腺功能亢进症（PHPT）与心血管疾病死亡率和发病率升高相关。然而，甲状旁腺激素（PTH）和/或钙在心血管疾病（CVD）发生发展中的确切作用仍存在争议。PHPT对止血的影响尚不清楚。因此，本研究的主要目的是调查内源性凝血/纤维蛋白溶解标志物，并评估这些止血参数、血清脂质谱以及PHPT患者血清钙和PTH之间的关系。
本研究纳入了23例PHPT患者和20例年龄匹配的健康对照者。检测了纤维蛋白原、V、VII、VIII、IX和X因子活性、血管性血友病因子（vWF）、抗凝血酶III（AT III）、蛋白C、蛋白S、组织纤溶酶原激活物（t-PA）和组织纤溶酶原激活物抑制剂-1（PAI-1），以及常见的脂蛋白变量。检查了生化参数与这些止血参数之间的关系。
与对照组相比，PHPT患者的血小板计数、FVII、FX活性和D-二聚体水平显著升高（分别为p<0.001、p<0.05、p<0.001和p<0.05）。在脂质方面，PHPT患者的总胆固醇（TC）、甘油三酯（TG）和低密度脂蛋白胆固醇（LDL-C）水平显著高于对照组（分别为p<0.01、p<0.001、p<0.001）。在PHPT患者中，尿磷排泄与VIII、IX和X因子之间呈正相关（r分别为0.572，p<0.01；r为0.543，p<0.01；r为0.532，p<0.01）。FIX活性与TC（r为0.463，p<0.05）和LDL-C（r为0.549，p<0.01）呈正相关。血清碱性磷酸酶（ALP）与PAI-1水平呈正相关（r为0.451，p<0.05）。载脂蛋白B（ApoB）与D-二聚体呈正相关（r为0.
