Rolighed Lars, Amstrup Anne Kristine, Jakobsen Niels Frederik Breum, Sikjaer Tanja, Mosekilde Leif, Christiansen Peer, Rejnmark Lars
Department of Surgery P, Aarhus University Hospital, Tage Hansens Gade 2, Aarhus C, 8000, Denmark,
World J Surg. 2014 Mar;38(3):549-57. doi: 10.1007/s00268-013-2273-5.
Patients with "asymptomatic" primary hyperparathyroidism (PHPT) often describe improvement after surgery.
We evaluated muscle and balance function, quality of life (QoL), and well-being in 58 PHPT patients and 58 population-based matched controls in a cross-sectional study. We tested whether patients considered "asymptomatic" according to international guidelines have functional impairment.
Mean age of the patients and controls was 59 years, and 47 (81 %) were women. Patients had higher levels of plasma PTH and ionized calcium. Creatinine and 25-hydroxyvitamin D levels did not differ between groups. Altogether, 16 (28 %) patients were "asymptomatic." Compared with controls, PHPT was associated with significantly lower QoL in all eight domains of the short form-36 questionnaire, lower well-being (WHO Five Well-Being Index; p < 0.001), and impaired postural stability during normal standing with eyes open (p < 0.05) or closed (p < 0.001). Maximum isometric muscle strength was reduced in both upper (p < 0.01) and lower (p < 0.001) extremities. Physical performance was decreased during 10 repeated chair stands (p < 0.001) and time to walk 3 m forward and back (p < 0.05). Restricting analyses to "asymptomatic" patients showed significantly lower muscle strength at knee extension and flexion and impaired postural stability than in matched controls.
PHPT is associated with deleterious effects on muscles and QoL. Impairments also apply to patients with mild disease, normally considered "asymptomatic." This may explain why "asymptomatic" patients report improvements following surgery. The impaired muscle function may contribute to increased fracture risk independent of bone mineral density.
“无症状”原发性甲状旁腺功能亢进症（PHPT）患者术后常称症状有所改善。
在一项横断面研究中，我们评估了58例PHPT患者和58例基于人群匹配的对照者的肌肉和平衡功能、生活质量（QoL）及幸福感。我们测试了根据国际指南被认为“无症状”的患者是否存在功能损害。
患者和对照者的平均年龄为59岁，47例（81%）为女性。患者的血浆甲状旁腺激素（PTH）和离子钙水平较高。两组间肌酐和25-羟维生素D水平无差异。共有16例（28%）患者“无症状”。与对照者相比，PHPT患者在简明健康状况调查问卷（Short Form-36）的所有八个领域的生活质量均显著较低，幸福感较低（世界卫生组织五福指数；p<0.001），睁眼（p<0.05）或闭眼（p<0.001）正常站立时姿势稳定性受损。上下肢的最大等长肌力均降低（上肢p<0.01，下肢p<0.001）。10次重复起坐测试（p<0.001）及向前和向后行走3米的时间（p<0.05）时身体表现下降。对“无症状”患者进行分析显示，与匹配的对照者相比，其膝关节屈伸肌力显著降低，姿势稳定性受损。
PHPT对肌肉和生活质量有不良影响。这些损害也适用于通常被认为“无症状”的轻症患者。这可能解释了为什么“无症状”患者术后症状会有所改善。肌肉功能受损可能导致骨折风险增加，而与骨密度无关。
