Thier Mark, Daudi Sébastien, Bergenfelz Anders, Almquist Martin
Department of Clinical Sciences, Lund University, Lund, Sweden.
Department of Surgery, Skane University Hospital Lund University, SE-221 85, Lund, Sweden.
Langenbecks Arch Surg. 2018 Feb;403(1):103-109. doi: 10.1007/s00423-017-1647-9. Epub 2018 Jan 2.
Primary hyperparathyroidism (pHPT) is caused by single- or multiglandular disease (MGD). Patients with MGD have an increased risk of complications at surgery and for persistence and recurrence after surgery. The study evaluated whether preoperative clinical and biochemical characteristics could predict MGD in patients with pHPT.
We retrospectively evaluated patients operated 1989-2013 for first-time, non-hereditary pHPT. MGD was defined in patients with more than one pathological gland excised at surgery or with persistent hypercalcemia after the excision of a single pathological parathyroid gland, confirmed by histopathology. Clinical and biochemical variables were compared in patients with single- and multiglandular disease. Logistic regression was used to identify variables predicting MGD, yielding odds ratios (OR) with 95% confidence intervals (CI).
There were 707 patients, of which 79 (11%) had MGD. Patients with MGD were more likely to have negative sestamibi scintigraphy than patients with single-gland disease, 15 of 49 (31%) vs. 70 of 402 (17%; p = 0.03), to suffer from diabetes (12 of 74, 16%) vs. 45 out of 626 patients (7.2%; p < 0.01) and had lower preoperative levels of urinary calcium (3.80 vs. 4.44 mmol/L; p = 0.04). Multivariable analysis identified negative scintigraphy (OR 2.42; 95% CI 1.18 to 4.79), diabetes (OR 2.75; 95% CI 1.31 to 4.97) and elevated levels of osteocalcin (OR 3.79, 95% CI: 1.75 to 8.21) as predictors of MGD.
Negative sestamibi scintigraphy, diabetes and elevated osteocalcin levels were predictors of MGD.
原发性甲状旁腺功能亢进症（pHPT）由单腺体或多腺体疾病（MGD）引起。MGD患者手术时并发症风险增加，术后持续性和复发性风险也增加。本研究评估术前临床和生化特征能否预测pHPT患者的MGD。
我们回顾性评估了1989年至2013年首次接受手术的非遗传性pHPT患者。MGD定义为手术切除一个以上病理腺体的患者，或切除单个病理甲状旁腺后仍存在高钙血症且经组织病理学证实的患者。比较单腺体和多腺体疾病患者的临床和生化变量。采用逻辑回归分析确定预测MGD的变量，得出比值比（OR）及95%置信区间（CI）。
共有707例患者，其中79例（11%）患有MGD。与单腺体疾病患者相比，MGD患者更可能出现锝[99mTc]甲氧基异丁基异腈（sestamibi）闪烁扫描阴性，49例中有15例（31%），而402例中有70例（17%；p = 0.03）；更易患糖尿病（74例中有12例，16%），而626例患者中有45例（7.2%；p < 0.01），且术前尿钙水平较低（3.80 vs. 4.44 mmol/L；p = 0.04）。多变量分析确定闪烁扫描阴性（OR 2.42；95% CI 1.18至4.79）、糖尿病（OR 2.75；95% CI 1.31至4.97）和骨钙素水平升高（OR 3.79，95% CI：1.75至8.21）为MGD的预测因素。
sestamibi闪烁扫描阴性、糖尿病和骨钙素水平升高是MGD的预测因素。
