Kaderli Reto M, Riss Philipp, Geroldinger Angelika, Selberherr Andreas, Scheuba Christian, Niederle Bruno
Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Wien, Austria.
Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Clin Endocrinol (Oxf). 2017 Jul;87(1):97-102. doi: 10.1111/cen.13348. Epub 2017 May 5.
Normal or elevated 24-hour urinary calcium (Ca) excretion is a diagnostic marker in primary hyperparathyroidism (PHPT). It is used to distinguish familial hypocalciuric hypercalcaemia (FHH) from PHPT by calculating the Ca/creatinine clearance ratio (CCCR). The variance of CCCR in patients with PHPT is considerable. The aim of this study was to analyse the parameters affecting CCCR in patients with PHPT.
The data were collected prospectively. Patients with sporadic PHPT undergoing successful surgery were included in a retrospective analysis.
The analysis covered 381 patients with pre-operative workup 2 days before removal of a solitary parathyroid adenoma.
The impact of serum Ca and 25-hydroxyvitamin D3 (25-OH D3) on CCCR.
The coefficient of determination (R ) in the multivariable model for CCCR consisting of age, Ca, 25-OH D3, 1,25-dihydroxyvitamin D3 (1,25-(OH)2 D3), testosterone (separately for males and females), intact parathyroid hormone (iPTH) and osteocalcin was 25.8%. The only significant parameters in the multivariable analysis were 1,25-(OH)2 D3 and osteocalcin with a drop in R of 15.4% (P<.001) and 2.4% (P=.006), respectively. Bone mineral densities at the lumbar spine, distal radius and left femoral neck were not associated with CCCR (r=-.08, r=-.10 and r=-0.09).
In multivariable analysis, 1,25-(OH)2 D3 and osteocalcin were the only factors correlating with CCCR. Vitamin D3 replacement may therefore impair the diagnostic value of CCCR and increase the importance of close monitoring of urinary Ca excretion during treatment.
24小时尿钙排泄正常或升高是原发性甲状旁腺功能亢进症（PHPT）的一项诊断标志物。通过计算钙/肌酐清除率（CCCR），它被用于鉴别家族性低钙血症性高钙血症（FHH）与PHPT。PHPT患者中CCCR的变异性相当大。本研究的目的是分析影响PHPT患者CCCR的参数。
前瞻性收集数据。对成功接受手术的散发性PHPT患者进行回顾性分析。
分析涵盖了381例在切除孤立性甲状旁腺腺瘤前两天接受术前检查的患者。
血清钙和25-羟基维生素D3（25-OH D3）对CCCR的影响。
由年龄、钙、25-OH D3、1,25-二羟基维生素D3（1,25-(OH)2 D3）、睾酮（分别针对男性和女性）、完整甲状旁腺激素（iPTH）和骨钙素组成的CCCR多变量模型中的决定系数（R²）为25.8%。多变量分析中唯一显著的参数是1,25-(OH)2 D3和骨钙素，R²分别下降了15.4%（P<0.001）和2.4%（P=0.006）。腰椎、桡骨远端和左股骨颈的骨密度与CCCR无关（r=-0.08，r=-0.10和r=-0.09）。
在多变量分析中，1,25-(OH)2 D3和骨钙素是与CCCR相关的唯一因素。因此，维生素D3替代可能会损害CCCR的诊断价值，并增加治疗期间密切监测尿钙排泄的重要性。
