Dundee Epidemiology and Biostatistics Unit, Division of Clinical and population Sciences and Education, MacKenzie Building, Kirsty Semple Way, University of Dundee, Dundee, Scotland, DD2 4BF, UK.
QJM. 2011 Jun;104(6):513-21. doi: 10.1093/qjmed/hcq261. Epub 2011 Jan 25.
Primary hyperparathyroidism (PHPT) is a common endocrine disorder with the majority of cases being mild and untreated.
To provide an update on the natural history of treated and untreated PHPT.
Retrospective population-based observational study.
From 1997 to 2006, a well-defined cohort of PHPT patients was established in Tayside, Scotland. Subsequent cohorts of 'mild untreated' and 'surgically treated' PHPT patients were selected for the present study. Their serum calcium (S-Ca) and PTH concentrations were followed until September 2009. Surgical outcomes were evaluated using hospital admission data.
A total of 904 'mild untreated' patients were identified (median follow-up=4.7 years), with a baseline median S-Ca of 2.62 mmol/l. A general decreased trend was observed in the S-Ca concentration for up to 12 years but an increasing trend in PTH (P<0.001 in both instances). Disease progression, defined as an increase in S-Ca concentration, was observed in 121 patients (13.4%). Twenty-six (2.9%) patients had undergone surgery during the subsequent follow-up period. Baseline age and PTH concentration were the only significant risk factors for disease progression. In comparison, there were 200 'surgically treated' patients (median follow-up=5.8 years). S-Ca was normalised after surgery, in 196 patients (98%). Hospital admissions for renal complications were reduced after surgery. In conclusion, most untreated patients with mild PHPT had no progression of S-Ca but approximately 15% did show some evidence of progression. Parathyroidectomy, with a high success rate, normalized the S-Ca in patients with PHPT.
原发性甲状旁腺功能亢进症（PHPT）是一种常见的内分泌疾病，大多数病例为轻度且未经治疗。
提供治疗和未治疗的 PHPT 的自然病史更新。
回顾性基于人群的观察性研究。
1997 年至 2006 年，在苏格兰泰赛德建立了一个明确的 PHPT 患者队列。随后选择了“轻度未经治疗”和“手术治疗”的 PHPT 患者队列进行本研究。直到 2009 年 9 月，他们的血清钙（S-Ca）和 PTH 浓度被随访。手术结果通过住院数据进行评估。
共确定了 904 名“轻度未经治疗”的患者（中位随访时间=4.7 年），基线中位数 S-Ca 为 2.62mmol/l。在长达 12 年的时间里，S-Ca 浓度呈普遍下降趋势，但 PTH 呈上升趋势（两者均 P<0.001）。在 121 名患者中观察到疾病进展，定义为 S-Ca 浓度增加。26 名（2.9%）患者在随后的随访期间接受了手术。基线年龄和 PTH 浓度是疾病进展的唯一显著危险因素。相比之下，有 200 名“手术治疗”的患者（中位随访时间=5.8 年）。手术后 S-Ca 恢复正常，196 名患者（98%）。手术后，肾脏并发症的住院治疗减少。总之，大多数轻度 PHPT 未经治疗的患者 S-Ca 没有进展，但约 15%的患者确实显示出一些进展的迹象。甲状旁腺切除术成功率高，可使 PHPT 患者的 S-Ca 正常化。
