多种腺体疾病和术中甲状旁腺激素下降较慢是轻度原发性甲状旁腺功能亢进的特征。
Multigland disease and slower decline in intraoperative PTH characterize mild primary hyperparathyroidism.
机构信息
Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, K3/704 Clinical Science Center, Madison, WI, USA,
出版信息
Ann Surg Oncol. 2013 Dec;20(13):4205-11. doi: 10.1245/s10434-013-3190-4. Epub 2013 Aug 14.
BACKGROUND
Many patients with primary hyperparathyroidism (PHPT) present with less severe biochemical parameters. The purpose of this study was to compare the presentation, operative findings, and outcomes of these patients with "mild" PHPT to patients with "overt" disease.
METHODS
A retrospective review of a prospectively collected parathyroid database was performed to identify cases of PHPT undergoing an initial neck operation. Patients were classified as mild when either the preoperative calcium or PTH was within the normal limits. Comparisons were made with the Student's t test, Chi-squared test, or Wilcoxon rank-sum test where appropriate. Kaplan-Meier estimates were plotted for disease-free survival and compared by the log-rank test.
RESULTS
Of the 1,429 patients who met inclusion criteria, 1,049 were classified as overt and 388 (27.1 %) were mild. Within the mild group, 122 (31.4 %) presented with normocalcemic PHPT and 266 (68.6 %) had a normal PTH. The two groups had similar demographics and renal function. Interestingly, the mild group had more than double the rate of kidney stones (3.1 vs. 1.3 %, p = 0.02). The mild group was less likely to localize on sestamibi scan (62.4 vs. 78.7 %, p < 0.01). Intraoperatively, more mild patients exhibited multigland disease (34.3 vs. 14.1 %, p < 0.01). When examining intraoperative PTH (IoPTH) kinetics where single adenomas were excised, the IoPTH fell at a rate of 6.9 pg/min in mild patients compared with 11.5 pg/min in the overt group (p < 0.01). Accordingly, 62.2 % of patients in the overt group and 53.3 % in the mild group were cured at 5 min postexcision (p < 0.01). There was no difference in the rates of persistence or recurrence between the groups, and disease-free survival estimates were identical (p = 0.27).
CONCLUSIONS
Patients with mild PHPT were more likely to have multigland disease and a slower decline in IoPTH, but these patients can be successfully treated with surgery.
背景
许多原发性甲状旁腺功能亢进症（PHPT）患者的生化参数表现较轻。本研究旨在比较这些“轻度”PHPT 患者与“显性”疾病患者的临床表现、手术发现和结果。
方法
对前瞻性收集的甲状旁腺数据库进行回顾性分析，以确定接受初次颈部手术的 PHPT 病例。当术前血钙或 PTH 处于正常范围内时，患者被分类为轻度。使用学生 t 检验、卡方检验或威尔科克森秩和检验进行比较，视情况而定。绘制无病生存的 Kaplan-Meier 估计，并通过对数秩检验进行比较。
结果
在符合纳入标准的 1429 名患者中，1049 名被归类为显性，388 名（27.1%）为轻度。在轻度组中，122 名（31.4%）表现为血钙正常的 PHPT，266 名（68.6%）PTH 正常。两组的人口统计学和肾功能相似。有趣的是，轻度组肾结石的发生率高出两倍（3.1%比 1.3%，p=0.02）。轻度组 sestamibi 扫描定位的可能性较小（62.4%比 78.7%，p<0.01）。术中，更多的轻度患者表现为多腺体疾病（34.3%比 14.1%，p<0.01）。在检查单发性腺瘤切除术中的术中甲状旁腺激素（IoPTH）动力学时，轻度患者的 IoPTH 下降速度为 6.9 pg/min，而显性组为 11.5 pg/min（p<0.01）。因此，在 5 分钟的切除术后，显性组中有 62.2%的患者和轻度组中有 53.3%的患者被治愈（p<0.01）。两组之间的持续性或复发性无差异，无病生存估计值相同（p=0.27）。
结论
轻度 PHPT 患者更有可能有多腺体疾病和 IoPTH 下降速度较慢，但这些患者可以通过手术成功治疗。
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