Lips P, Netelenbos J C, van Doorn L, Hackeng W H, Lips C J
Department of Endocrinology, Free University Hospital, Amsterdam, The Netherlands.
Clin Endocrinol (Oxf). 1991 Jul;35(1):35-40. doi: 10.1111/j.1365-2265.1991.tb03493.x.
Because of an overlap between serum PTH values in healthy controls and hyperparathyroid patients we sought to evaluate a short stimulation and suppression test for differentiating the two groups.
Subjects were 34 patients with primary hyperparathyroidism (PHPT) and 25 healthy controls.
After stimulation with intravenous EDTA (10 mg/kg body weight in 5 minutes) blood samples were obtained for up to 15 minutes. After an oral calcium dose of 1 g, blood samples were obtained at 1 and 2 hours. After an intravenous calcium dose (2.5 mg/kg body weight in 30 seconds), blood samples were obtained serially for 20 minutes.
Serum PTH(1-84) was measured by a double antibody technique.
The intravenous EDTA test resulted in an average 2.6-fold increase of serum PTH(1-84) in hyperparathyroid patients, whereas it increased 10.5-fold in controls. A response was absent in three of 23 patients. There was an overlap in results between patients with mild hyperparathyroidism and controls. The oral calcium dose decreased serum PTH(1-84) in patients to 0.73 and in controls to 0.55 of the basal value, but six of 15 patients and two of 12 controls did not respond. The intravenous calcium test resulted in a drop of serum PTH(1-84) in hyperparathyroid patients to 0.51 and in control subjects to 0.40 of the basal value, and non-responders were not observed. There was a strong correlation between the responses to the EDTA and the calcium infusion tests in the patients (r = 0.97, P less than 0.01). Fasting serum calcium and serum PTH(1-84) showed a positive correlation in PHPT patients (r = 0.75, P less than 0.001) and a negative correlation in control subjects (r = -0.41, P less than 0.05). Based on these relationships, hyperparathyroid patients and controls could be completely separated.
The wide range of responses to stimulation and suppression tests and the correlation between these responses in hyperparathyroid patients indicate various degrees of autonomy. As the response to these tests is less marked in patients than in controls and both groups still overlap, these tests are not useful for the diagnosis of primary hyperparathyroidism.
由于健康对照者和甲状旁腺功能亢进患者的血清甲状旁腺激素（PTH）值存在重叠，我们试图评估一种短程刺激和抑制试验以区分这两组人群。
研究对象为34例原发性甲状旁腺功能亢进症（PHPT）患者和25名健康对照者。
静脉注射依地酸二钠（EDTA，10mg/kg体重，5分钟内注射完毕）进行刺激后，在长达15分钟的时间内采集血样。口服1g钙剂后，于1小时和2小时采集血样。静脉注射钙剂（2.5mg/kg体重，30秒内注射完毕）后，连续20分钟采集血样。
采用双抗体技术测定血清PTH（1-84）。
静脉注射EDTA试验使甲状旁腺功能亢进患者的血清PTH（1-84）平均升高2.6倍，而对照者升高了10.5倍。23例患者中有3例无反应。轻度甲状旁腺功能亢进患者与对照者的结果存在重叠。口服钙剂使患者血清PTH（1-84）降至基础值的0.73，对照者降至0.55，但15例患者中有6例、12例对照者中有2例无反应。静脉注射钙剂试验使甲状旁腺功能亢进患者的血清PTH（1-84）降至基础值的0.51，对照者降至0.40，未观察到无反应者。患者对EDTA试验和钙剂输注试验的反应之间存在强相关性（r = 0.97，P<0.01）。在PHPT患者中，空腹血清钙与血清PTH（1-84）呈正相关（r = 0.75，P<0.001），在对照者中呈负相关（r = -0.41，P<0.05）。基于这些关系，甲状旁腺功能亢进患者和对照者能够完全区分开。
甲状旁腺功能亢进患者对刺激和抑制试验的反应范围广泛，且这些反应之间存在相关性，提示存在不同程度的自主性。由于患者对这些试验的反应不如对照者明显，且两组仍有重叠，因此这些试验对原发性甲状旁腺功能亢进症的诊断无用。
