Fülöp Tibor, Koch Christian A, Farah Musa Abdeen R, Clark Christopher M, Gharaibeh Kamel A, Lengvársky Zsolt, Hamrahian Mehrdad, Pitman Karen T, Dixit Mehul P
Division of Nephrology, Diabetes and Metabolism, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Hemodial Int. 2018 Jul;22(3):394-404. doi: 10.1111/hdi.12639. Epub 2018 Feb 15.
The long-term results of surgical parathyroidectomy (PTX) in end-stage renal disease (ESRD) patients are less well known in the modern era of newer activated vitamin-D analogs, calcimimetics and intraoperative monitoring of parathyroid hormone (PTH).
We performed a retrospective chart review of all ESRD patients undergoing PTX at the University of Mississippi Medical Center between January 2005 and August 2011, with follow-up data as available up to 4 years. All PTXs were performed with intraoperative second-generation PTH monitoring and targeted gland size reduction.
The cohort (N = 37) was relatively young with a mean (±SD) age of 48.4 ± 13.9. 94.6% of the subjects were African American and 59.5% female. Preoperatively, 45.9% received cinacalcet (CNC) at a mean dose of 63.5 ± 20.9 mg. The size of the largest removed glands measured 1.7 ± 0.8 cm and almost all (94.6%) glands had hyperplasia on histology. The mean length of inpatient stay was 5.5 ± 2.4 days. Preoperative calcium/phosphorus measured 9.6 ± 1.2/6.6 ± 1.7 mg/dL with PTH concentrations of 1589 ± 827 pg/mL. Postoperative PTH values measured 145.4 ± 119.2 pg/mL. Preoperative PTH strongly correlated (P < 0.0001) with both alkaline phosphatase (ALP) levels (r: 0.596) and the number of inpatient days (r: 0.545), but not with CNC administration. Independent predictors for the duration of hospitalization were preoperative ALP (beta 0.469; P = 0.001) and age (beta -0.401; P = 0.005) (R 0.45); for postoperative hypocalcemia, age (beta: -0.321; P = 0.006) and preoperative PTH (beta: 0.431; P = 0.036) were significant in linear regression models with stepwise selection.
Gland-sparing PTX achieved acceptable control of ESRD-associated hyperparathyroidism in most patients from a socioeconomically challenged, underserved population of the United States.
在新型活性维生素D类似物、拟钙剂以及甲状旁腺激素（PTH）术中监测的现代时代，终末期肾病（ESRD）患者行甲状旁腺切除术（PTX）的长期结果鲜为人知。
我们对2005年1月至2011年8月在密西西比大学医学中心接受PTX的所有ESRD患者进行了回顾性病历审查，随访数据最长可达4年。所有PTX均在术中进行第二代PTH监测并进行目标腺体缩小术。
队列（N = 37）相对年轻，平均（±标准差）年龄为48.4±13.9岁。94.6%的受试者为非裔美国人，59.5%为女性。术前，45.9%的患者接受西那卡塞（CNC）治疗，平均剂量为63.5±20.9毫克。切除的最大腺体大小为1.7±0.8厘米，几乎所有（94.6%）腺体在组织学上都有增生。平均住院时间为5.5±2.4天。术前钙/磷水平为9.6±1.2/6.6±1.7毫克/分升，PTH浓度为1589±827皮克/毫升。术后PTH值为145.4±119.2皮克/毫升。术前PTH与碱性磷酸酶（ALP）水平（r：0.596）和住院天数（r：0.545）均呈强相关（P < 0.0001），但与CNC给药无关。住院时间的独立预测因素为术前ALP（β 0.469；P = 0.001）和年龄（β -0.401；P = 0.005）（R 0.45）；对于术后低钙血症，在逐步选择的线性回归模型中，年龄（β：-0.321；P = 0.006）和术前PTH（β：0.431；P = 0.036）具有显著性。
在美国社会经济条件差、医疗服务不足的人群中，大多数患者通过保留腺体的PTX实现了对ESRD相关甲状旁腺功能亢进的可接受控制。
