Division of Endocrinology and Metabolism, McGill University Health Center, Montreal, Quebec, Canada.
Endocrinology and Nephrology Unit, CHU de Québec Research Centre, Quebec City, Quebec, Canada.
Obes Surg. 2018 Jul;28(7):1886-1894. doi: 10.1007/s11695-017-3101-z.
Biliopancreatic diversion with duodenal switch (BPD-DS) decreases vitamin D and calcium absorption, which may result in secondary hyperparathyroidism. This study aimed at evaluating the prevalence of vitamin D deficiency and secondary hyperparathyroidism before and after BPD-DS.
A retrospective analysis of patients who had undergone BPD-DS at a tertiary bariatric center between 2003 and 2010 and for whom simultaneous measurements of serum 25-hydroxyvitamin D and parathyroid hormone were available within 5 years post-op was performed. The prevalence of vitamin D deficiency (< 20 ng/ml) and secondary hyperparathyroidism (> 65 pg/mL) at different time points was calculated.
Included were 1436 patients (mean ± SD, age 42.7 ± 10.4 years; BMI 51.5 ± 8.6 kg/m; 69.8% women). Prevalence of vitamin D deficiency decreased up to 6-12 months after surgery (from 35.8% at baseline down to 6-9%) then rose progressively, plateauing at 15.5% after 36 months. Prevalence of hyperparathyroidism was 28.5% before surgery and rose progressively after surgery, reaching 68.6% at 5 years. Mean serum corrected calcium increased from 0 to 6 months then decreased up to 36 months. Preoperatively, the prevalence of hypocalcemia was 7.3%. It increased after 12 months, attaining 26.9% at 48 months.
Prevalence of vitamin D deficiency and secondary hyperparathyroidism is high before BPD-DS. Despite a low prevalence of vitamin D deficiency after surgery, prevalence of hyperparathyroidism increased steadily 1 year after surgery, preceded by a decrease in serum calcium. Factors explaining the high prevalence of secondary hyperparathyroidism after BPD-DS and its long-term impact on bone health should be addressed.
胆胰分流十二指肠转位术（BPD-DS）会降低维生素 D 和钙的吸收，从而导致继发性甲状旁腺功能亢进。本研究旨在评估 BPD-DS 术前和术后维生素 D 缺乏和继发性甲状旁腺功能亢进的发生率。
对 2003 年至 2010 年在一家三级减肥中心接受 BPD-DS 治疗且术后 5 年内同时有血清 25-羟维生素 D 和甲状旁腺激素检测结果的患者进行回顾性分析。计算不同时间点维生素 D 缺乏（<20ng/ml）和继发性甲状旁腺功能亢进（>65pg/ml）的发生率。
共纳入 1436 例患者（平均年龄±标准差，42.7±10.4 岁；BMI 51.5±8.6kg/m2；69.8%为女性）。术后 6-12 个月时，维生素 D 缺乏的发生率下降（从术前的 35.8%降至 6-9%），随后逐渐升高，36 个月后稳定在 15.5%。术前甲状旁腺功能亢进的发生率为 28.5%，术后逐渐升高，术后 5 年时达到 68.6%。校正后血清钙平均值在 0-6 个月时升高，然后在 36 个月时下降。术前低钙血症的发生率为 7.3%，术后 12 个月时增加，48 个月时达到 26.9%。
BPD-DS 术前维生素 D 缺乏和继发性甲状旁腺功能亢进的发生率较高。尽管术后维生素 D 缺乏的发生率较低，但甲状旁腺功能亢进的发生率在术后 1 年稳步上升，血清钙先下降。应该研究 BPD-DS 后继发性甲状旁腺功能亢进发生率高的原因及其对骨骼健康的长期影响。
