Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China.
World J Surg. 2010 Jun;34(6):1350-5. doi: 10.1007/s00268-009-0377-8.
Concurrent vitamin D(3) deficiency is common in primary hyperparathyroidism (pHPT). We aimed to examine the clinicopathologic features and short-term outcomes of vitamin D(3)-deficient patients after minimally invasive parathyroidectomy (MIP).
Over 2-year period, 80 consecutive MIP patients had preoperative-fasting 25-hydroxyvitamin D(3) (25OHD(3)) checked. Forty-five patients had a 25OHD(3) level <20 ng/ml and were defined as deficient. Intraoperative parathyroid hormone (IOPTH) assay was used for all MIP. Postoperative adjusted calcium (Ca) was checked at 6, 16 (with intact PTH), and 24 h. Oral calcium and vitamin D supplements were given if hypocalcemic symptoms developed or Ca < 2.00 mmol/l. Late-onset hypocalcemia (LOH) was defined as symptoms developed after 24 h.
Both deficient and nondeficient groups had similar demographic data and bone density scores. The deficient group had significantly higher PTH (190 vs. 121 pg/ml, p = 0.015). Although IOPTH in the deficient group were higher at induction and 0 min after excision, the percentage drop from induction to 10 min after excision was similar. Ca was similar at 6 and 16 h in the two groups but was significantly lower in the deficient group at 24 h (2.10 vs. 2.45 mmol/l, p = 0.033). At 1 week, the proportion of LOH was significantly higher in the deficient group (12/42 vs. 3/34, p = 0.043) and in those with preoperative PTH > 100 pg/ml (15/57 vs. 0/19, p = 0.013).
Vitamin D(3) deficiency was associated with a higher preoperative PTH level and a greater risk of LOH after MIP. However, the likely cause of LOH remains unclear as both low preoperative vitamin D(3) and high PTH levels could be responsible.
原发性甲状旁腺功能亢进症（pHPT）患者常同时伴有维生素 D（3）缺乏。本研究旨在探讨微创甲状旁腺切除术（MIP）后维生素 D（3）缺乏患者的临床病理特征和短期转归。
在 2 年的时间里，对 80 例行 MIP 的患者进行术前空腹 25-羟维生素 D（3）（25OHD（3））检查。45 例患者的 25OHD（3）水平<20ng/ml，定义为缺乏。所有 MIP 患者均采用术中甲状旁腺激素（IOPTH）测定。术后 6、16（甲状旁腺激素完整）和 24 小时检查调整后的血钙（Ca）。如果出现低钙血症症状或 Ca<2.00mmol/l，则给予口服钙剂和维生素 D 补充剂。术后迟发性低钙血症（LOH）定义为术后 24 小时出现症状。
缺乏组和非缺乏组的患者在人口统计学数据和骨密度评分方面无显著差异。缺乏组的 PTH 明显较高（190 比 121pg/ml，p=0.015）。尽管缺乏组在诱导和切除后 0 分钟时 IOPTH 较高，但从诱导到切除后 10 分钟时的百分比下降是相似的。两组患者在 6 小时和 16 小时时的 Ca 水平相似，但缺乏组在 24 小时时的 Ca 水平明显较低（2.10 比 2.45mmol/l，p=0.033）。在 1 周时，缺乏组的 LOH 比例明显更高（12/42 比 3/34，p=0.043），且术前甲状旁腺激素>100pg/ml 的患者比例也更高（15/57 比 0/19，p=0.013）。
维生素 D（3）缺乏与 MIP 术后发生 LOH 的风险增加相关，这与术前甲状旁腺激素水平升高有关。然而，LOH 的可能原因尚不清楚，因为低术前维生素 D（3）和高甲状旁腺激素水平都可能是其发生的原因。
