治愈性手术治疗散发性原发性甲状旁腺功能亢进症后的停药。

Medication discontinuation after curative surgery for sporadic primary hyperparathyroidism.

机构信息

Section of Endocrine Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

出版信息

Surgery. 2010 Dec;148(6):1113-8; discussion 1118-9. doi: 10.1016/j.surg.2010.09.008.

DOI:10.1016/j.surg.2010.09.008

PMID:21134541

Abstract

BACKGROUND

Although parathyroidectomy (Ptx) for sporadic primary hyperparathyroidism (PH) improves comorbidities and symptoms, routine Ptx for minimally symptomatic PH remains controversial. Whether successful Ptx translates into discontinuation or dose-reduction of prescribed medications is unknown.

METHODS

Consecutive patients undergoing curative Ptx for sporadic PH from January 2007 to April 2009 were compared to patients undergoing thyroidectomy (Tx). We reviewed patient demographics, symptoms, comorbid conditions, and pre- and postoperative medications utilizing the Fisher exact test and t test for comparisons.

RESULTS

Compared to 176 Tx patients, 260 Ptx patients were older (P < .001), more commonly men (P = .006), and had higher preoperative prevalences of every examined PH symptom and comorbid condition. Postoperatively, even minimal PH symptoms improved after Ptx. The mean number of preoperative medications was higher in Ptx patients (4 vs 2.8, P < .001). Discontinuation or dose-reduction of medication occurred in 28 (11%) Ptx patients vs 7 (4%) Tx patients (P = .01). After Ptx, symptom improvement was the predominant reason for beneficial medication changes, and the most common beneficial effect was discontinuation or dose-reduction of chronic analgesics (33%).

CONCLUSION

PH symptoms are numerous and improve after curative Ptx. Medication use for related symptoms can be beneficially reduced by surgery. Drug profiles should be routinely reviewed and adjusted after parathyroidectomy.

摘要

背景

甲状旁腺切除术（Ptx）可治疗散发性原发性甲状旁腺功能亢进症（PH），改善相关并发症和症状，但对于症状轻微的 PH 是否进行常规 Ptx 仍存在争议。成功的 Ptx 是否会导致停止或减少规定药物的剂量尚不清楚。

方法

回顾性分析 2007 年 1 月至 2009 年 4 月期间接受甲状旁腺切除术（Ptx）治疗的散发性 PH 患者，并与同期接受甲状腺切除术（Tx）的患者进行比较。利用 Fisher 确切概率法和 t 检验比较患者的人口统计学资料、症状、并存疾病以及术前和术后用药情况。

结果

与 176 例 Tx 患者相比，260 例 Ptx 患者年龄更大（P<0.001），男性更常见（P=0.006），且术前所有 PH 症状和并存疾病的患病率更高。Ptx 术后即使是轻微的 PH 症状也有所改善。Ptx 患者术前用药的平均数量更高（4 种 vs 2.8 种，P<0.001）。28 例（11%）Ptx 患者停药或减少药物剂量，而 Tx 患者中仅有 7 例（4%）（P=0.01）。Ptx 后，症状改善是药物变化有益的主要原因，最常见的有益作用是停止或减少慢性镇痛药的使用（33%）。