Saxe A W, Lincenberg S, Hamburger S W
Department of Surgery, Sinai Hospital of Detroit, MI 48235.
Surgery. 1987 Nov;102(5):840-5.
A strong correlation between the biochemical manifestations of hyperparathyroidism and the volume of abnormal parathyroid tissue could be used to guide the extent of surgical exploration and parathyroid gland resection (i.e., finding a small "adenoma" in a patient with marked hypercalcemia would dictate further exploration). We examined this relationship in patients for whom data were collected prospectively (n = 14) and retrospectively (n = 27). We considered only patients cured after excision of a single gland and glands for which a three-dimensional description or volume of water displacement was available. To exclude artifactually elevated serum concentrations of parathyroid hormone (PTH), PTH values were used only from patients with levels of serum creatinine less than 2 mg/dl. To accommodate different assays, highest preoperative PTH, ionized calcium, and alkaline phosphatase (AP) values were expressed as percent above upper normal limit. There was excellent agreement (r = 0.93, p less than 0.05) between measured and calculated gland volume. In the prospective study (but not in the retrospective study) there was a significant (p less than 0.05) correlation (r = 0.61) between gland volume and highest preoperative total calcium value; however, there was considerable variation in gland size in patients with similar calcium levels. In neither study was there a significant correlation between gland volume and any of the following: calcium, ionized calcium, midregional PTH, carboxyterminal PTH, or intact PTH, alkaline phosphatase, and urine cyclic adenosine monophosphate (AMP). In the prospective study there was a tendency for urine cyclic AMP, ionized calcium, and AP to increase with increasing gland volume (r = 0.42, 0.45, and 0.51, respectively). Preoperative measurements of calcium, PTH, urine cyclic AMP, and AP are too inconsistent to rely on for determining the extent of parathyroid gland resection.
甲状旁腺功能亢进的生化表现与异常甲状旁腺组织的体积之间存在很强的相关性，可用于指导手术探查范围和甲状旁腺切除术（即，在血钙明显升高的患者中发现一个小的“腺瘤”将决定进一步的探查）。我们对前瞻性收集数据的患者（n = 14）和回顾性收集数据的患者（n = 27）研究了这种关系。我们仅考虑在切除单个腺体后治愈的患者以及可获得三维描述或水置换体积的腺体。为排除甲状旁腺激素（PTH）血清浓度的人为升高，仅使用血清肌酐水平低于2 mg/dl患者的PTH值。为适应不同检测方法，术前最高PTH、离子钙和碱性磷酸酶（AP）值表示为高于正常上限的百分比。测量的腺体体积与计算的腺体体积之间具有极好的一致性（r = 0.93，p < 0.05）。在前瞻性研究中（但回顾性研究中未发现），腺体体积与术前最高总钙值之间存在显著相关性（p < 0.05，r = 0.61）；然而，血钙水平相似的患者腺体大小存在相当大的差异。在两项研究中，腺体体积与以下任何一项均无显著相关性：钙、离子钙、中段PTH、羧基末端PTH或完整PTH、碱性磷酸酶以及尿环磷酸腺苷（AMP）。在前瞻性研究中，尿环AMP、离子钙和AP有随腺体体积增加而升高的趋势（分别为r = 0.42、0.45和0.51）。术前钙、PTH、尿环AMP和AP的测量结果过于不一致，无法依靠它们来确定甲状旁腺切除术的范围。
