甲状旁腺手术后高钙尿症仍可能持续存在，且与甲状旁腺增生有关。

Hypercalciuria May Persist After Successful Parathyroid Surgery and It Is Associated With Parathyroid Hyperplasia.

机构信息

Unit of Endocrinology and Metabolic Diseases (S.P., C.E.-V., E.C., V.M., A.S., I.C.), Endocrine Surgery Unit (L.V.), and Division of Pathology (S.F.), Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; and Department of Clinical Sciences and Community Health (S.P., E.C., V.M., V.V.Z., U.V., M.F., A.S.) and Department of Biomedical, Surgical and Dental Sciences (S.F.), University of Milan, 20122 Milan, Italy.

出版信息

J Clin Endocrinol Metab. 2015 Jul;100(7):2734-42. doi: 10.1210/jc.2014-4548. Epub 2015 May 8.

DOI:10.1210/jc.2014-4548

PMID:25955223

Abstract

CONTEXT

Hypercalciuria is frequently found in primary hyperparathyroidism (1HPT) and, although it generally normalizes after successful parathyroidectomy, may persist in some patients. The factors associated with persistent calcium renal leak (cRL) have not been clarified.

OBJECTIVE

The purpose of this study was to determine the prevalence of cRL in our 1HPT population and investigate cRL-related factors.

DESIGN

This was a retrospective longitudinal study.

SETTING

The study was conducted in an outpatient setting.

PATIENTS/INTERVENTION: The participants were 95 patients with 1HPT successfully operated on who had a normal estimated glomerular filtration rate.

MAIN OUTCOME MEASURES

The biochemical parameters of calcium metabolism and bone mineral density (BMD) measured by dual-X-ray absorptiometry before and 24 months after surgery were assessed. All histological findings were recorded.

RESULTS

The prevalence of hypercalciuria before and after surgery was 74% and 32%, respectively. Before, surgery patients with cRL showed lower calcium and higher phosphate levels than those without cRL (10.9 ± 0.6 vs 11.4 ± 0.8 mg/dL [2.7 ± 0.2 vs 2.8 ± 0.2 mmol/L], P = .01 and 2.6 ± 0.5 vs 2.4 ± 0.4 mg/dL [0.84 ± 0.2 vs 0.77 ± 0.1 mmol/L], P = .04, respectively), whereas 24-h calciuria levels and the prevalence of 1HPT complications (osteoporosis, renal stones, and hypertension) were comparable. After surgery, serum calcium, phosphate, and PTH levels were comparable between patients with and without cRL. The prevalence of the histological finding of parathyroid hyperplasia was higher in patients with cRL (50%) than in patients without cRL (22%) (P = .01). The presence of cRL was independently associated with presurgery hypercalciuria (odds ratio, 4.71; 95% confidence interval, 1.18-18.8; P = .03) and parathyroid hyperplasia (odds ratio, 3.52; 95% confidence interval, 1.31-9.43; P = .01). Only patients without cRL had improved BMD at the spine (P = .04), total femur (P = .01), and femoral neck (P = .01).

CONCLUSIONS

cRL is present in 30% of patients with 1HPT after successful surgery, and it is associated with parathyroid hyperplasia before surgery and the lack of improvement in BMD after surgery.

摘要

背景

高钙尿症在原发性甲状旁腺功能亢进症（1HPT）中经常发现，尽管在甲状旁腺切除术成功后通常会恢复正常，但在一些患者中仍可能持续存在。与持续钙肾漏（cRL）相关的因素尚未阐明。

目的

本研究的目的是确定我们的 1HPT 人群中 cRL 的患病率，并探讨与 cRL 相关的因素。

设计

这是一项回顾性纵向研究。

地点

研究在门诊进行。

患者/干预措施：95 名成功接受手术的 1HPT 患者符合条件，他们的估算肾小球滤过率正常。

主要观察指标

手术前后通过双能 X 线吸收法测量的钙代谢和骨密度（BMD）的生化参数。记录所有组织学发现。

结果

手术前后高钙尿症的患病率分别为 74%和 32%。手术前，有 cRL 的患者的钙水平较低，磷水平较高，而无 cRL 的患者则相反（10.9 ± 0.6 与 11.4 ± 0.8mg/dL[2.7 ± 0.2 与 2.8 ± 0.2mmol/L]，P =.01；2.6 ± 0.5 与 2.4 ± 0.4mg/dL[0.84 ± 0.2 与 0.77 ± 0.1mmol/L]，P =.04），而 24 小时尿钙水平和 1HPT 并发症（骨质疏松症、肾结石和高血压）的患病率相当。手术后，cRL 患者的血清钙、磷和 PTH 水平与无 cRL 的患者相当。有 cRL 的患者甲状旁腺增生的组织学发现发生率（50%）高于无 cRL 的患者（22%）（P =.01）。cRL 的存在与术前高钙尿症（优势比，4.71；95%置信区间，1.18-18.8；P =.03）和甲状旁腺增生（优势比，3.52；95%置信区间，1.31-9.43；P =.01）独立相关。只有无 cRL 的患者在脊柱（P =.04）、全股骨（P =.01）和股骨颈（P =.01）的 BMD 有改善。