Nilsson Inga-Lena, Norenstedt Sophie, Zedenius Jan, Pernow Ylva, Bränström Robert
Department of Molecular Medicine and Surgery, Section of Endocrine Surgery, Karolinska Institutet, Solona, Sweden; Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Section of Endocrine Surgery, Karolinska Institutet, Solona, Sweden; Department of Surgery, Capio St Görans Hospital, Stockholm, Sweden.
Surgery. 2017 Aug;162(2):429-436. doi: 10.1016/j.surg.2017.02.017. Epub 2017 May 15.
In primary hyperparathyroidism, successful parathyroidectomy leads to improved bone mineral density in the majority of cases. Our aim was to further explore the relationship between hypercalciuria, kidney function, and bone recovery after parathyroidectomy.
Bone mineral density, estimated glomerular filtration rate, and 24-hour urinary calcium were analyzed before and one year after parathyroidectomy in a cohort of 150 primary hyperparathyroidism patients (119 women; median age 60 [range 30-80] years) taking part in a clinical trial. The patients were randomized to 1-year daily treatment with either cholecalciferol 1,600 IU and calcium carbonate 1,000 mg or calcium carbonate alone.
Baseline 24-hour urinary calcium correlated directly with s-calcium, parathyroid hormone, 25-OH-D, the bone markers beta C-terminal telopeptide of type 1 collagen and procollagen type 1 amino-terminal propeptide, and estimated glomerular filtration rate (r = 0.19-0.30; P < .05) and inversely with age (r = -0.25; P = .004); 24-hour urinary calcium decreased and bone mineral density in lumbar spine and hip increased similarly in the 2 groups. Baseline 24-hour urinary calcium in the highest quartile (>10 mmol/d) was associated with greater increases in all locations. In a multivariable model adjusting for age, sex, smoking, diabetes, body mass index, estimated glomerular filtration rate, baseline bone mineral density, and vitamin D group, the increase in total hip bone mineral density remained independently associated with baseline 24-hour urinary calcium in the highest quartile (>10 mmol/d) and with plasma parathyroid hormone. Patients with persistent increases in 24-hour urinary calcium at follow-up (14%) had similar bone mineral density improvement.
Overall, 24-hour urinary calcium > 10 mmol/d was an independent determinant of improvement in bone mineral density and should be taken into account when considering parathyroidectomy.
在原发性甲状旁腺功能亢进症中，大多数情况下成功的甲状旁腺切除术可使骨矿物质密度得到改善。我们的目的是进一步探讨甲状旁腺切除术后高钙尿症、肾功能与骨恢复之间的关系。
对参与一项临床试验的150例原发性甲状旁腺功能亢进症患者（119名女性；中位年龄60岁[范围30 - 80岁]）在甲状旁腺切除术前及术后一年分析骨矿物质密度、估计肾小球滤过率和24小时尿钙。患者被随机分为两组，一组接受为期1年的每日1600 IU胆钙化醇和1000 mg碳酸钙治疗，另一组仅接受碳酸钙治疗。
基线24小时尿钙与血清钙、甲状旁腺激素、25 - 羟基维生素D、骨标志物1型胶原β - C末端肽和1型前胶原氨基末端前肽以及估计肾小球滤过率呈直接相关（r = 0.19 - 0.30；P < 0.05），与年龄呈负相关（r = -0.25；P = 0.004）；两组患者的24小时尿钙均下降，腰椎和髋部的骨矿物质密度均有相似程度的增加。最高四分位数（>10 mmol/d）的基线24小时尿钙与所有部位更大程度的增加相关。在调整年龄、性别、吸烟、糖尿病、体重指数、估计肾小球滤过率、基线骨矿物质密度和维生素D组的多变量模型中，全髋骨矿物质密度的增加仍与最高四分位数（>10 mmol/d）的基线24小时尿钙以及血浆甲状旁腺激素独立相关。随访时24小时尿钙持续升高的患者（14%）骨矿物质密度改善情况相似。
总体而言，24小时尿钙>10 mmol/d是骨矿物质密度改善的独立决定因素，在考虑甲状旁腺切除术时应予以考虑。
