Valle Díaz de la Guardia Francisco, Arrabal Martín Miguel, Arrabal Polo Miguel Angel, Quirosa Flores Susana, Miján Ortiz Jose Luis, Zuluaga Gómez Armando
Urology Department and Reumatology Department, Hospital Clinico San Cecilio de Granada, Granada, Spain.
Arch Esp Urol. 2010 Jan-Feb;63(1):32-40.
The relationship between hyperparathyroidism and lithiasis is quite known, so the study of parathyroid glands is especially mandatory in the face of relapses. Our objective is to analyze both primary hyperparathyroidism (PHPT) associated with renal lithiasis and the evolution of this condition after parathyroidectomy, as well as to study factors associated with the presence of lithiasis or bone pathology, and carry out a review on bibliography.
We describe a retrospective study of a series comprising 287 cases of hyperparathyroidism: 237 of them were primary and the remaining 50, secondary. We have included: sex, age, evolution time and symptoms, diagnostic tests (biochemical, radiological and histological). Factors such as number of episodes prior to diagnosis and treatments were analyzed in patients with symptomatic lithiasis to know whether patients exhibited residual lithiasis after the management of calculi or whether patients underwent episodes after parathyroidectomy, or whether or not they were treated. Statistical analysis was carried out through SPSS 15.0 for Windows.
Forty five percent of the patients had suffered lithiasis episodes; 50%, osteopenia/osteoporosis; 23%, musculoskeletal pain; 23%, asthenia and/or depressive syndrome. In 13.5% of cases, diagnosis was supported by the presence of hypercalcemia; no other symptoms were detected. We have analyzed factors that favor or inhibit renal lithiasis formation and compared biochemical parameters from the group of primary hyperthyroidism that exhibited lithiasis (41 patients) with those patients who did not (49). We noted that lithiasis patients showed higher values of calcium, alkaline phosphatase, intact PTH, mean PTH, osteocalcin, and chlorine/phosphate, calciuria and phosphaturia indexes. Student's t test on two independent samples revealed significant statistical differences in calcium levels (p<0.05), intact PTH (<.05) and osteocalcin.
Primary hyperparathyroidism patients with lithiasis presented higher values of parathormone, alkaline phosphatase, osteocalcin, and Cl/P and calciuria indexes than lithiasis-free PHPT patients. These patients exhibit objective improvement of symptoms after parathyroidectomy, and rarely a recurrence of lithiasis, a factor that generally coincides with persistence of residual lithiasis.
甲状旁腺功能亢进与结石形成之间的关系已为人熟知，因此在面对复发情况时，对甲状旁腺的研究尤为必要。我们的目的是分析与肾结石相关的原发性甲状旁腺功能亢进症（PHPT）及其甲状旁腺切除术后的病情演变，研究与结石或骨病变存在相关的因素，并对文献进行综述。
我们描述了一项对287例甲状旁腺功能亢进症病例的回顾性研究：其中237例为原发性，其余50例为继发性。我们纳入了：性别、年龄、病程及症状、诊断检查（生化、放射学和组织学）。对有症状结石患者的诊断前发作次数和治疗等因素进行分析，以了解患者在结石处理后是否有残余结石，或甲状旁腺切除术后是否发作，以及是否接受过治疗。通过Windows版SPSS 15.0进行统计分析。
45%的患者有结石发作史；50%有骨质减少/骨质疏松；23%有肌肉骨骼疼痛；23%有乏力和/或抑郁综合征。13.5%的病例诊断依据是高钙血症，未检测到其他症状。我们分析了促进或抑制肾结石形成的因素，并将有结石的原发性甲状旁腺功能亢进组（41例患者）与无结石的患者（49例）的生化参数进行了比较。我们注意到有结石的患者钙、碱性磷酸酶、完整甲状旁腺激素、平均甲状旁腺激素、骨钙素以及氯/磷、尿钙和尿磷指数值较高。对两个独立样本进行的学生t检验显示，钙水平（p<0.05）、完整甲状旁腺激素（<.05）和骨钙素存在显著统计学差异。
有结石的原发性甲状旁腺功能亢进患者的甲状旁腺激素、碱性磷酸酶、骨钙素以及Cl/P和尿钙指数值高于无结石的PHPT患者。这些患者在甲状旁腺切除术后症状有客观改善，结石很少复发，这一因素通常与残余结石的持续存在一致。
