Liu Jessica Y, Saunders Neil D, Chen Aaron, Weber Collin J, Sharma Jyotirmay
Division of General Surgery, Department of Surgery, Emory University, Atlanta, Georgia, USA.
Am Surg. 2016 Sep;82(9):839-45.
Neuropsychiatric symptoms (NPSs) of sporadic primary hyperparathyroidism (PHPT) are often subtle and effects of parathyroidectomy (PTX) on symptoms remains poorly characterized. Our aim was to evaluate effects of PTX on NPS in patients with PHPT. A prospective questionnaire was distributed to all patients undergoing PTX and to a thyroidectomy (TX) control group. The questionnaire included the validated scales Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) to assess for depression and anxiety respectively, as well as questions modified from Pasieka's Parathyroid Assessment of Symptoms (M-PAS). Point values were assigned to questionnaire answers to create a score, with a maximum of 63. Fifty-eight patients underwent PTX (58.6%) and 41 TX (41.4%). Mean preoperative scores were greater in PTX versus TX patients in total score, PHQ-9, GAD-7, and M-PAS (all P < 0.05). Post-PTX scores were lower than pre-PTX in total score, PHQ-9, GAD-7, and M-PAS (all P < 0.05), but not in pre- and post-TX. Post-PTX 69.0 and 82.8 per cent of patients showed no symptoms of depression and anxiety, respectively, compared with 37.9 and 56.9 per cent pre-PTX. A total of 16.2 and 10.3 per cent of patients had moderately severe to severe depression and anxiety, which fell to 0 per cent post-PTX. NPSs are more common in patients with PHPT when compared with TX. Patients undergoing PTX have improvements in NPS. NPS scoring should occur in all patients with PHPT and severity of NPS should be considered a relative indication for PTX.
散发性原发性甲状旁腺功能亢进症（PHPT）的神经精神症状（NPSs）通常较为隐匿，甲状旁腺切除术（PTX）对这些症状的影响仍未得到充分描述。我们的目的是评估PTX对PHPT患者NPS的影响。我们向所有接受PTX的患者以及甲状腺切除术（TX）对照组发放了一份前瞻性问卷。该问卷包括经过验证的量表，即患者健康问卷-9（PHQ-9）和广泛性焦虑症-7（GAD-7），分别用于评估抑郁和焦虑，以及从帕西埃卡甲状旁腺症状评估量表修改而来的问题（M-PAS）。对问卷答案赋予分值以得出一个分数，最高分为63分。58例患者接受了PTX（58.6%），41例接受了TX（41.4%）。PTX患者术前总分、PHQ-9、GAD-7和M-PAS的平均得分均高于TX患者（所有P<0.05）。PTX术后总分、PHQ-9、GAD-7和M-PAS得分均低于PTX术前（所有P<0.05），但TX术前和术后得分无差异。PTX术后分别有69.0%和82.8%的患者无抑郁和焦虑症状，而PTX术前分别为37.9%和56.9%。共有16.2%和10.3%的患者有中度至重度抑郁和焦虑，PTX术后降至0%。与TX患者相比，NPSs在PHPT患者中更常见。接受PTX的患者NPS有改善。所有PHPT患者均应进行NPS评分，NPS的严重程度应被视为PTX的一个相对指征。
