Lavryk Olga A, Siperstein Allan E
Department of Endocrine Surgery Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH.
Department of Endocrine Surgery Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH.
Surgery. 2017 Apr;161(4):1139-1148. doi: 10.1016/j.surg.2016.10.021. Epub 2016 Nov 29.
At 12 months after a parathyroid operation, we expect cured patients to have biochemical profiles similar to those of healthy individuals. The aim of the current study was to compare the biochemical characteristics patients at 12 months after parathyroidectomy for primary sporadic hyperparathyroidism with those of healthy controls.
A total of 547 patients who underwent parathyroid neck operation for primary sporadic hyperparathyroidism from 2000-2014 were analyzed. A control group consisted of 74 healthy subjects. Calcium and parathyroid hormone were collected perioperatively. Graphic plots of the relationship between calcium versus parathyroid hormone (95% confidence intervals) were used to compare the biochemical profiles of patients after parathyroid operation and controls.
Preoperatively, patients with primary sporadic hyperparathyroidism had a calcium level of 10.9 ± 0.5 mg/dL and parathyroid hormone level of 124.4 ± 68.5 pg/dL vs controls' values of 9.2 ± 0.3 mg/dL and 34.4 ± 13.4 pg/dL, respectively. Before operation, all primary sporadic hyperparathyroidism patients had calcium versus parathyroid hormone values outside the normal zone. At 12 months after operation, 335 (69%) patients showed normalization of the chemical profile; 13 (2.7%) had absolute elevation of calcium and parathyroid hormone, reflecting persistent disease; 2 (0.4%) patients had hypoparathyroidism after subtotal parathyroidectomy; and 149 (31%) had calcium and parathyroid hormone values outside the normal zone, not fitting into the above categories. There were no marked differences between patients with simple adenoma those with multiple-gland disease.
Longer follow-up might be needed for patients after parathyroid operation to confirm stabilization of biochemical profiles.
在甲状旁腺手术后12个月，我们期望治愈的患者具有与健康个体相似的生化指标。本研究的目的是比较原发性散发性甲状旁腺功能亢进症患者甲状旁腺切除术后12个月时的生化特征与健康对照组的生化特征。
分析了2000年至2014年期间因原发性散发性甲状旁腺功能亢进症接受甲状旁腺颈部手术的547例患者。对照组由74名健康受试者组成。围手术期收集钙和甲状旁腺激素。使用钙与甲状旁腺激素之间关系的图形图（95%置信区间）来比较甲状旁腺手术后患者与对照组的生化指标。
术前，原发性散发性甲状旁腺功能亢进症患者的钙水平为10.9±0.5mg/dL，甲状旁腺激素水平为124.4±68.5pg/dL，而对照组的值分别为9.2±0.3mg/dL和34.4±13.4pg/dL。手术前，所有原发性散发性甲状旁腺功能亢进症患者的钙与甲状旁腺激素值均超出正常范围。术后12个月，335例（69%）患者的生化指标恢复正常；13例（2.7%）患者的钙和甲状旁腺激素绝对升高，提示疾病持续存在；2例（0.4%）患者在次全甲状旁腺切除术后出现甲状旁腺功能减退；149例（31%）患者的钙和甲状旁腺激素值超出正常范围，不属于上述类别。单纯腺瘤患者与多腺体疾病患者之间无明显差异。
甲状旁腺手术后的患者可能需要更长时间的随访以确认生化指标是否稳定。
