1st Department of Surgery, Laiko Athens General Hospital, University of Athens, 17 Agiou Thoma Street, 11527 Athens, Greece.
2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, 11528 Athens, Greece.
Int J Endocrinol. 2015;2015:984935. doi: 10.1155/2015/984935. Epub 2015 Apr 9.
Objective. Nutritional deficiencies are common after bariatric surgery. We aimed to assess the prevalence and possible predictors of secondary hyperparathyroidism (SHPT) in bariatric patients. Methods. A total of 95 patients who had undergone Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) were assessed after a median of 3 years after surgery. Anthropometric/demographic and weight-loss parameters were compared according to the presence of SHPT, independently for men/premenopausal women and postmenopausal women. Results. SHPT was highly prevalent (men/premenopausal women, 52.1%; postmenopausal women, 31.9%). Among men/premenopausal women, multivariate analysis indicated that SHPT was predicted by (a) 25-hydroxyvitamin D levels (Exp(B) = 0.869, P-value = 0.037), independently of age, sex, smoking; (b) calcium (Exp(B) = 0.159, P-value = 0.033) and smoking, independently of age and sex; (c) magnesium (Exp(B) = 0.026, P-value = 0.046) and smoking, independently of age and sex. Among postmenopausal women, SHPT was predicted by menopausal age independently of age, smoking, and levels of 25-hydroxyvitamin D or calcium. The development of SHPT was not associated with the type of surgery. Conclusions. RYGB and SG exhibited similar effects regarding the regulation of the hypothalamus-pituitary-parathyroid axis after surgery. Vitamin D status and menopausal age appear to determine SHPT on the long term. SHPT should be sought and vigorously treated with calcium and vitamin D supplementation.
减重手术后常发生营养缺乏。本研究旨在评估肥胖症患者发生继发性甲状旁腺功能亢进症（SHPT）的患病率及其可能的预测因素。
共评估了 95 例行 Roux-en-Y 胃旁路术（RYGB）或袖状胃切除术（SG）的患者，这些患者术后中位数时间为 3 年。根据 SHPT 的存在情况，分别对男性/绝经前女性和绝经后女性的人体测量学/人口统计学和减重参数进行比较。
SHPT 的患病率较高（男性/绝经前女性为 52.1%，绝经后女性为 31.9%）。在男性/绝经前女性中，多变量分析表明，SHPT 由以下因素预测：（a）25-羟维生素 D 水平（Exp（B）=0.869，P 值=0.037），独立于年龄、性别和吸烟；（b）钙（Exp（B）=0.159，P 值=0.033）和吸烟，独立于年龄和性别；（c）镁（Exp（B）=0.026，P 值=0.046）和吸烟，独立于年龄和性别。在绝经后女性中，SHPT 仅由绝经年龄预测，与年龄、吸烟、25-羟维生素 D 或钙水平无关。SHPT 的发生与手术类型无关。
RYGB 和 SG 在术后对下丘脑-垂体-甲状旁腺轴的调节作用相似。维生素 D 状态和绝经年龄似乎决定了长期的 SHPT。应寻找 SHPT 并积极进行钙和维生素 D 补充治疗。
