肥胖对原发性甲状旁腺功能亢进症临床表现的影响。
The impact of obesity on the presentation of primary hyperparathyroidism.
作者信息
Tran Hien, Grange Jacob S, Adams-Huet Beverley, Nwariaku Fiemu E, Rabaglia Jennifer L, Woodruff Stacey L, Holt Shelby A, Maalouf Naim M
机构信息
The Charles and Jane Pak Center for Mineral Metabolism and Clinical Research (H.T., J.S.G., N.M.M.), Departments of Internal Medicine (H.T., B.A.-H., N.M.M.), Clinical Sciences (B.A.-H.), and Surgery (F.E.N., J.I.R., S.L.W., S.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390-8885.
出版信息
J Clin Endocrinol Metab. 2014 Jul;99(7):2359-64. doi: 10.1210/jc.2013-3903. Epub 2014 Mar 31.
CONTEXT
Obesity has been associated with elevated serum PTH (sPTH) in the general population. Obesity may also alter the clinical presentation in patients with primary hyperparathyroidism (PHPT).
OBJECTIVES
The objectives of the study were to compare the clinical presentation of obese (OB) vs nonobese (NO) PHPT patients and to assess the impact of obesity on the presentation of PHPT independent of serum calcium and PTH.
PATIENTS
Consecutive PHPT patients who underwent parathyroidectomy between 2003 and 2012 by a single surgical group participated in the study.
SETTING
The study was conducted at an academic medical center.
DESIGN
Cross-sectional review of records of preoperative demographic, historical, laboratory, and densitometry findings and intraoperative pathological findings were compared in OB vs NO patients.
MAIN OUTCOME MEASURES
The prevalence of nephrolithiasis and osteoporosis was measured.
RESULTS
Two hundred forty-seven PHPT patients were included in this analysis. Fifty percent were OB and 79% were women. Mean body mass index was 25.3 ± 3.3 and 36.0 ± 5.2 kg/m(2) in the NO and OB groups, respectively. Age, gender, and race distribution was similar between the two groups. Serum calcium was similar between the groups (11.0 ± 0.7 mg/dL in NO vs 11.1 ± 0.9 mg/dL in OB, P = .13), whereas sPTH was higher in OB (151 ± 70 vs 136 ± 69 pg/mL, P = .03). The OB group exhibited higher prevalence of hypercalciuria (urine calcium > 400 mg per 24 h) (41% vs 23% in NO, P = .01) and nephrolithiasis (36% vs 21% in NO, P = .03). Despite higher sPTH, OB patients showed higher bone mineral density and a lower rate of osteoporosis (21% vs 35%, P = .05). Differences in the prevalence of hypercalciuria and osteoporosis between the groups persisted after adjustment for age, race, estimated glomerular filtration rate, gender, sPTH, and calcium.
CONCLUSIONS
In PHPT patients, obesity is a risk factor for hypercalciuria and nephrolithiasis and is protective against osteoporosis. The impact of parathyroidectomy on the clinical features of obese PHPT patients merits further evaluation.
背景
在普通人群中，肥胖与血清甲状旁腺激素（sPTH）升高有关。肥胖还可能改变原发性甲状旁腺功能亢进症（PHPT）患者的临床表现。
目的
本研究的目的是比较肥胖（OB）与非肥胖（NO）的PHPT患者的临床表现，并评估肥胖对PHPT临床表现的影响，且不受血清钙和甲状旁腺激素的影响。
患者
2003年至2012年间由同一手术团队进行甲状旁腺切除术的连续性PHPT患者参与了本研究。
地点
本研究在一家学术医疗中心进行。
设计
对术前人口统计学资料、病史、实验室检查、骨密度测定结果以及术中病理检查结果进行横断面回顾，比较OB组和NO组患者的情况。
主要观察指标
测量肾结石和骨质疏松症的患病率。
结果
本分析纳入了247例PHPT患者。其中50%为肥胖患者，79%为女性。NO组和OB组的平均体重指数分别为25.3±3.3和36.0±5.2kg/m²。两组间年龄、性别和种族分布相似。两组间血清钙水平相似（NO组为11.0±0.7mg/dL，OB组为11.1±0.9mg/dL，P = 0.13），而OB组的sPTH水平较高（151±70 vs 136±69pg/mL，P = 0.03）。OB组高钙尿症（尿钙>400mg/24h）的患病率较高（41% vs NO组的23%，P = 0.01），肾结石患病率也较高（36% vs NO组的21%，P = 0.03）。尽管OB组的sPTH水平较高，但其骨密度较高，骨质疏松症发生率较低（21% vs 35%，P = 0.05）。在对年龄、种族、估计肾小球滤过率、性别、sPTH和钙进行校正后，两组间高钙尿症和骨质疏松症患病率的差异仍然存在。
结论
在PHPT患者中，肥胖是高钙尿症和肾结石的危险因素，对骨质疏松症具有保护作用。甲状旁腺切除术对肥胖PHPT患者临床特征的影响值得进一步评估。
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