Rajeev P, Movseysan A, Baharani A
Department of Endocrine Surgery, National University Hospital , Singapore.
Department of Endocrine and General Surgery, St Mary's Hospital, Newport , Isle of Wight , UK.
Ann R Coll Surg Engl. 2017 Sep;99(7):559-562. doi: 10.1308/rcsann.2017.0092.
Introduction Involvement of the bone is common in primary hyperparathyroidism. The aim of the study was to assess bone turnover markers in response to surgery for primary hyperparathyroidism. Methods This was a retrospective study of patients diagnosed and treated for parathyroid disease between 2005 and 2012. Interventions studied were surgery and medical treatment. The main outcome measures studied were serum levels of calcium, intact parathyroid hormone (iPTH), bone-specific alkaline phosphatase, N-terminal cross-linking propeptide of type 1 procollagen (P1NP) and C-terminal cross-linking telopeptides of type I collagen (CTX), both pre- and postoperatively at 6 months and 1 year; bone mineral density (at the spine and hip assessed by dual-energy x-ray absorptiometry after 1 year of treatment. Results A total of 122 (110 female, 12 male) patients (age range 25-91 years) underwent treatment for parathyroid disease during the study period; 30 patients were treated conservatively and 92 proceeded to surgery following localisation studies. Following surgical intervention, P1NP dropped significantly from a mean of 64.68 ng/ml (standard deviation, SD ± 68.07 ng/ml) preoperatively to 26.37 ng/ml (SD ± 20.94 ng/ml) and CTX from 0.69 pg/ml (SD ± 0.44 pg/ml) to 0.15 pg/ml (SD ± 0.16 pg/ml) at 6-12 months (P < 0.0001). This change was reflected in improvement in bone mineral density (T scores) of the hip and spine by 43% (P < 0.03) and 38% (P < 0.01), respectively, following surgery. In patients treated conservatively (n = 30), there was no improvement either in the bone turnover markers or bone densitometry scans. Conclusions Surgery improves bone density in patients with parathyroid disease. Improvement in serum bone turnover markers is seen following parathyroidectomy. The association with bone density needs further evaluation in larger studies.
引言 骨骼受累在原发性甲状旁腺功能亢进症中很常见。本研究的目的是评估原发性甲状旁腺功能亢进症手术治疗后骨转换标志物的变化。方法 这是一项对2005年至2012年间诊断并治疗甲状旁腺疾病患者的回顾性研究。所研究的干预措施为手术和药物治疗。所研究的主要结局指标为术前、术后6个月和1年时血清钙、完整甲状旁腺激素（iPTH）、骨特异性碱性磷酸酶、I型前胶原N端交联前肽（P1NP）和I型胶原C端交联端肽（CTX）的水平；治疗1年后通过双能X线吸收法评估脊柱和髋部的骨密度。结果 在研究期间，共有122例患者（110例女性，12例男性，年龄范围25 - 91岁）接受了甲状旁腺疾病治疗；30例患者接受保守治疗，92例在定位研究后进行了手术。手术干预后，6 - 12个月时P1NP从术前平均64.68 ng/ml（标准差，SD ± 68.07 ng/ml）显著降至26.37 ng/ml（SD ± 20.94 ng/ml），CTX从0.69 pg/ml（SD ± 0.44 pg/ml）降至0.15 pg/ml（SD ± 0.16 pg/ml）（P < 0.0001）。这种变化反映在手术后髋部和脊柱的骨密度（T值）分别提高了43%（P < 0.03）和38%（P < 0.01）。在接受保守治疗的患者（n = 30）中，骨转换标志物或骨密度扫描均无改善。结论 手术可改善甲状旁腺疾病患者的骨密度。甲状旁腺切除术后血清骨转换标志物有所改善。骨密度与骨转换标志物之间的关联需要在更大规模的研究中进一步评估。
