继发性和三发性甲状旁腺功能亢进症：ioPTH 监测的应用。
Secondary and tertiary hyperparathyroidism: the utility of ioPTH monitoring.
机构信息
Department of Surgery, Section of Endocrine Surgery, University of Wisconsin, 600 Highland Avenue, Clinical Science Center H4/722, Madison, WI 53792-3284, USA.
出版信息
World J Surg. 2010 Jun;34(6):1343-9. doi: 10.1007/s00268-010-0575-4.
BACKGROUND
The aim of the present study was to examine the utility of intraoperative parathyroid hormone (ioPTH) monitoring in patients with secondary (2) and tertiary (3) hyperparathyroidism (HPT).
MATERIALS AND METHODS
We identified 105 patients with 2HPT (n = 33) and 3HPT (n = 72) who underwent ioPTH monitoring during parathyroidectomy. Data are reported as mean +/- SEM.
RESULTS
The 2HPT patients underwent 17 subtotal, 10 total, and 6 re-exploratory parathyroidectomies, whereas the 3HPT patients underwent 54 subtotal, 15 limited, and 3 re-exploratory parathyroidectomies. The percent decrease from the baseline ioPTH level at 5, 10, and 15 min after parathyroid resection, respectively, were 72% +/- 3%, 76% +/- 3%, and 76% +/- 3% in patients with 2HPT, and 52% +/- 6%, 60% +/- 4%, and 69% +/- 4% in patients with 3HPT. IoPTH levels failed to drop >50% from baseline in 5 patients (2HPT: n = 2, 3HPT: n = 3) who were normocalcemic at last follow-up. IoPTH did not alter the surgical approach in any 2HPT patients, but did alter management in 25% of 3HPT patients (15 limited resections and 3 supernumerary glands). Normocalcemia was achieved in 97% of 2HPT patients and 99% of 3HPT patients; 2 patients developed recurrent disease.
CONCLUSIONS
Intraoperative PTH levels fell by >50% in nearly 95% of patients with 2HPT and 3HPT, and the PTH level reliably predicted postoperative cure. Although the use of ioPTH did not alter surgical management in any patient with 2HPT, this rapid PTH assay affected the surgical care of a quarter of the patients with 3HPT, and it may prove to be a useful adjunct in this group of patients.
背景
本研究旨在探讨术中甲状旁腺激素（ioPTH）监测在继发性（2 级）和三级（3 级）甲状旁腺功能亢进（HPT）患者中的应用价值。
材料与方法
我们共纳入了 105 例行 ioPTH 监测的 2 级 HPT（n=33）和 3 级 HPT（n=72）患者。数据以均数±SEM 表示。
结果
2 级 HPT 患者分别接受了 17 例次次全切除术、10 例全切除术和 6 例再次探查术，而 3 级 HPT 患者分别接受了 54 例次次全切除术、15 例有限切除术和 3 例再次探查术。甲状旁腺切除后 5、10 和 15 分钟，基线 ioPTH 水平的百分比下降分别为 72%±3%、76%±3%和 76%±3%，而在 3 级 HPT 患者中，分别为 52%±6%、60%±4%和 69%±4%。5 例患者（2 级 HPT：n=2，3 级 HPT：n=3）在末次随访时血钙正常，但其 ioPTH 水平未能较基线下降>50%。ioPTH 并未改变任何 2 级 HPT 患者的手术方式，但改变了 3 级 HPT 患者中 25%（15 例有限切除术和 3 例副腺体）的治疗方案。97%的 2 级 HPT 患者和 99%的 3 级 HPT 患者达到了正常血钙水平；2 例患者复发。
结论
近 95%的 2 级 HPT 和 3 级 HPT 患者的术中 PTH 水平下降>50%，且 PTH 水平可靠地预测了术后治愈。虽然 ioPTH 的使用并未改变任何 2 级 HPT 患者的手术管理，但该快速 PTH 检测方案影响了 3 级 HPT 患者四分之一的手术护理，并且在该组患者中可能证明是有用的辅助手段。
Zotero 插件