Adler Joel T, Sippel Rebecca S, Chen Herbert
Department of Surgery, University of Wisconsin, Madison, WI, USA.
Ann Surg Oncol. 2010 Nov;17(11):2958-62. doi: 10.1245/s10434-010-1125-x. Epub 2010 Jun 11.
Deficiency of 25-hydroxyvitamin D (25OHD) is a stimulus for the secretion of parathyroid hormone (PTH). During surgery for primary hyperparathyroidism, 25OHD deficiency may artificially elevate PTH, decreasing the sensitivity of intraoperative PTH (ioPTH) measurements.
Of 351 patients with known 25OHD status who underwent curative surgical treatment of primary hyperparathyroidism, 198 (56%) patients were 25OHD deficient (<25 ng/mL). A curative decrease in ioPTH was defined as a greater than 50% PTH decrease 5, 10, or 15 min after resection.
There was no statistical difference between 25OHD deficient and sufficient patients in PTH, phosphorous, and alkaline phosphatase preoperatively. There was a positive correlation between PTH and calcium, alkaline phosphatase, and gland weight, while there was an inverse correlation between preoperative PTH and 25OHD. The average ioPTH decrease was not significantly different after 5, 10, or 15 min, and 25OHD status did not affect when ioPTH indicated surgical cure.
Lower 25OHD levels are correlated with higher PTH and alkaline phosphatase levels in patients with primary hyperparathyroidism. 25OHD status did not affect the average percent ioPTH decrease or the rate of cure. 25OHD deficiency does not affect ioPTH dynamics.
25-羟维生素D（25OHD）缺乏是甲状旁腺激素（PTH）分泌的刺激因素。在原发性甲状旁腺功能亢进症手术期间，25OHD缺乏可能会人为地升高PTH，降低术中PTH（ioPTH）测量的敏感性。
在351例已知25OHD状态并接受原发性甲状旁腺功能亢进症根治性手术治疗的患者中，198例（56%）患者存在25OHD缺乏（<25 ng/mL）。ioPTH的根治性降低定义为切除后5、10或15分钟PTH降低超过50%。
25OHD缺乏和充足的患者术前PTH、磷和碱性磷酸酶无统计学差异。PTH与钙、碱性磷酸酶和腺体重量呈正相关，而术前PTH与25OHD呈负相关。5、10或15分钟后ioPTH的平均降低无显著差异，25OHD状态不影响ioPTH提示手术治愈的时间。
原发性甲状旁腺功能亢进症患者中较低的25OHD水平与较高的PTH和碱性磷酸酶水平相关。25OHD状态不影响ioPTH的平均降低百分比或治愈率。25OHD缺乏不影响ioPTH动态变化。
