Casella Claudio, Molfino Sarah, Mittempergher Francesco, Cappelli Carlo, Portolani Nazario
Department of Molecular and Translational Medicine, Surgical Clinic, University of Brescia, Brescia, Italy.
Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy.
Int J Endocrinol. 2018 Mar 6;2018:5010287. doi: 10.1155/2018/5010287. eCollection 2018.
Aim of this study is to evaluate determinants of secondary normocalcemic hyperparathyroidism (SNHPT) persistence in patients who have undergone Roux-en-Y gastric bypass on vertical-banded gastroplasty.
226 consecutive patients submitted to bariatric surgery were prospectively enrolled and divided in two groups on the basis of preoperative presence of SNHPT. For each patient, we evaluated anthropometric and laboratory parameters. Calcium metabolism (calcemia, PTH, and 25-hydroxy vitamin D serum levels) was studied before surgery and at 6-month intervals (6, 12, and 18 months) as surgical follow-up.
Based on presurgical SNHPT presence or absence, we defined 201 patients and 25 patients, respectively. Among the , 153 (76%) recovered from this endocrinopathy within 6 months after surgery (), while the remaining 48 patients (24%) had persistent SNHPT (). Comparing the anthropometric and laboratory data of with , the only statistically significant factor was the elapsed time since a prior effective medically controlled diet that led to a steady and substantial weight loss. We found also a statistically significant difference ( < 0.05) between and in term of % of weight loss and PTH levels.
Patients suitable for bariatric surgery must have history of at least one efficient medically controlled diet, not dating back more than 5 years before surgery. This elapsed time represent the cut-off time within which it is possible to recover from SNHPT in the first semester after Roux-en-Y gastric bypass on vertical-banded gastroplasty. The treatment of vitamin D insufficiency and the evaluation of SNHPT before bariatric surgery should be recommended. The clinical significance of preoperative SNHPT and in particular SNHPT after bariatric surgery remains undefined and further studies are required.
本研究旨在评估接受 Roux-en-Y 胃旁路术或垂直束带胃成形术的患者继发性血钙正常性甲状旁腺功能亢进症（SNHPT）持续存在的决定因素。
前瞻性纳入 226 例接受减肥手术的连续患者，并根据术前是否存在 SNHPT 将其分为两组。对于每位患者，我们评估了人体测量学和实验室参数。在手术前以及作为手术随访的 6 个月间隔期（6、12 和 18 个月）研究钙代谢（血钙、甲状旁腺激素和 25-羟维生素 D 血清水平）。
根据术前是否存在 SNHPT，我们分别定义了 201 例患者和 25 例患者。其中，153 例（76%）在手术后 6 个月内从这种内分泌病中康复（），而其余 48 例患者（24%）患有持续性 SNHPT（）。比较有持续性 SNHPT 患者和康复患者的人体测量学和实验室数据，唯一具有统计学意义的因素是自先前有效的医学控制饮食导致体重稳定且大幅减轻以来所经过的时间。我们还发现，在体重减轻百分比和甲状旁腺激素水平方面，有持续性 SNHPT 患者和康复患者之间存在统计学显著差异（<0.05）。
适合减肥手术的患者必须有至少一次有效的医学控制饮食史，且该饮食史距离手术时间不超过 5 年。这段经过的时间代表了在 Roux-en-Y 胃旁路术或垂直束带胃成形术后第一学期内有可能从 SNHPT 中康复的截止时间。应推荐在减肥手术前治疗维生素 D 不足并评估 SNHPT。术前 SNHPT 的临床意义，尤其是减肥手术后 SNHPT 的临床意义仍不明确，需要进一步研究。
