Cao Shaobo, Hu Ya, Zhao Yiming, Su Zhe, Xu Zhiyan, Gao Xiang, Liao Quan, Zhao Yupei
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China.
Oncotarget. 2017 Aug 24;8(60):101158-101164. doi: 10.18632/oncotarget.20416. eCollection 2017 Nov 24.
We retrospectively analyzed the relationship between normocalcemic parathormone elevation (NPE) and recurrence of primary hyperparathyroidism (pHPT) after surgery, as well as the risk factors of NPE. Out of 309 patients with pHPT that underwent parathyroidectomy. Six months after surgery, 75 patients exhibited NPE with high preoperative serum levels of alkaline phosphatase, calcium and intact parathyroid hormone (iPTH), postoperative day 1 iPTH, and large parathyroid volume. 15 exhibited NPE at 2 years after surgery with low serum vitamin D levels. Postoperative serum iPTH levels gradually normalized in most patients. Multivariate analysis showed that male patients were at greater risk for postoperative NPE (p<0.05). Only 3 of 309 patients showed recurrence during the follow-up period. NPE may not predict recurrent hyperparathyroidism or incomplete parathyroidectomy for benign parathyroid lesions. Postoperative NPE thus appears to be a response to severe hyperparathyroidism and vitamin D deficiency.
我们回顾性分析了血钙正常的甲状旁腺激素升高（NPE）与原发性甲状旁腺功能亢进症（pHPT）术后复发之间的关系，以及NPE的危险因素。在309例行甲状旁腺切除术的pHPT患者中，术后6个月，75例患者出现NPE，其术前血清碱性磷酸酶、钙和完整甲状旁腺激素（iPTH）水平较高，术后第1天iPTH水平较高，甲状旁腺体积较大。15例在术后2年出现NPE，血清维生素D水平较低。大多数患者术后血清iPTH水平逐渐恢复正常。多因素分析显示男性患者术后发生NPE的风险更高（p<0.05）。309例患者中只有3例在随访期间出现复发。NPE可能无法预测良性甲状旁腺病变的甲状旁腺功能亢进复发或甲状旁腺切除术不完全。因此，术后NPE似乎是对严重甲状旁腺功能亢进和维生素D缺乏的一种反应。
