Yamanouchi Masayuki, Ubara Yoshifumi, Hayami Noriko, Suwabe Tatsuya, Hiramatsu Rikako, Sumida Keiichi, Hasegawa Eiko, Hoshino Junichi, Sawa Naoki, Tanaka Kiho, Marui Yuji, Nakamura Michio, Tomikawa Shinji, Takaichi Kennmei
Nephrology Center, Toranomon Hospital, Tokyo, Japan.
Clin Nephrol. 2013 May;79(5):380-6. doi: 10.5414/CN107661.
Whether bone mineral density (BMD) is improved at 5 years after parathyroidectomy (PTx) for secondary hyperparathyroidism (SHPT) remains unknown.
To investigate BMD after PTx by dual energy X-ray absorptiometry (DXA).
BMD was measured at the distal 1/3 of the radius (non-shunt side) and at the lumbar supine (L2-L4, lateral view) before and 5 years after PTx in 35 hemodialysis patients who had undergone surgery from April 1994 to May 2004. The data were analyzed retrospectively.
Intact PTH decreased significantly from 1,100 ± 530 (range: 446 - 2,300) pg/ ml before PTx to 75 ± 68 (2 - 251) pg/ml at 5 years after PTx (p < 0.01). Before PTx, the radial BMD and lumbar BMD were both decreased -3.3 ± 1.9 SD and -1.3 ± 2.4 SD compared with the corresponding normal mean T-score, respectively. Radial BMD increased significantly from 0.522 ± 0.113 g/cm2 before PTx to 0.545 ± 0.114 g/cm2 (p = 0.01) at 5 years after PTx, while the T-score improved to -2.8 ± 2.0 SD. In contrast, lumbar BMD showed no significant change between before (0.734 ± 0.202 g/cm2) and 5 years after PTx (0.746 ± 0.199 g/cm2), and neither did the T-score (-1.1 ± 2.3 SD). None of the patients suffered any fractures during follow up.
These findings indicate that maintaining iPTH at < 300 pg/ml for 5 years after PTx results in an increase of radial BMD in SHPT patients with preoperative BMD levels in the osteoporosis range (below -2.5 SD) according to the WHO, as well as stabilizing lumbar BMD.
甲状旁腺切除术后5年，继发性甲状旁腺功能亢进症（SHPT）患者的骨密度（BMD）是否改善仍不清楚。
通过双能X线吸收法（DXA）研究甲状旁腺切除术后的骨密度。
对1994年4月至2004年5月接受手术的35例血液透析患者，在甲状旁腺切除术前及术后5年测量桡骨远端1/3（非分流侧）和腰椎仰卧位（L2-L4，侧位）的骨密度。对数据进行回顾性分析。
甲状旁腺切除术前完整甲状旁腺激素（iPTH）从1100±530（范围：446-2300）pg/ml显著降至术后5年的75±68（2-251）pg/ml（p<0.01）。甲状旁腺切除术前，桡骨骨密度和腰椎骨密度与相应正常平均T值相比分别降低了-3.3±1.9标准差和-1.3±2.4标准差。甲状旁腺切除术后5年，桡骨骨密度从术前的0.522±0.113g/cm²显著增加至0.545±0.114g/cm²（p=0.01），而T值改善至-2.8±2.0标准差。相比之下，腰椎骨密度在甲状旁腺切除术前（0.734±0.202g/cm²）和术后5年（0.746±0.199g/cm²）之间无显著变化，T值也无变化（-1.1±2.3标准差）。随访期间无患者发生骨折。
这些发现表明，对于术前骨密度水平处于世界卫生组织定义的骨质疏松范围（低于-2.5标准差）的SHPT患者，甲状旁腺切除术后5年将iPTH维持在<300pg/ml可使桡骨骨密度增加，并稳定腰椎骨密度。
