Department of Nephrology, Affiliated Hospital of Nantong University, 20 Xisi Road Nantong, Nantong, Jiangsu Province, China.
Department of Nephrology, Second Affiliated Hospital of Nanjing Medical University, 262 Zhongshan North Road, Nanjing, Jiangsu Province, China.
BMC Nephrol. 2018 Jun 15;19(1):142. doi: 10.1186/s12882-018-0934-1.
The patients with secondary hyperparathyroidism (SHPT) usually had reduced bone mineral density, which might lead to a substantial increase in osteoporosis, fracture and mortality. Although surgical intervention is effective in reducing parathyroid hormone (PTH) levels in suitable candidates refractory to medical therapy, the effect of surgery on bone mass changes still requires further evaluation. Thus, the aim of this study was to evaluate the characteristics of BMD changes after total parathyroidectomy (PTX) without autotransplantation and its associated factors.
The records of 34 patients who underwent successful total PTX without autotransplantation with a preoperative and postoperative dual energy X-ray absorptiometry (DEXA) scan in our institution within 4 years of operative intervention were reviewed. Correlation and regression analysis were used to identify factors that independently predict BMD changes.
At baseline, we found that the prevalence of osteoporosis seemed to be much higher in the load-bearing lumbar spine than in the hip, varying greatly even between different lumbar vertebrae. The bone loss in SHPT had its predilection site in the load-bearing cancellous bone. After curative total PTX without autotransplantation, BMD improved significantly in both lumbar spine and hip overall. The largest increase in BMD occurred at L4 vertebrae with the lowest pre-operative BMD. At the most affected site L4, BMD improved in up to 94.1% of patients: 86.2% had significant improvement, 5.9% moderate improvement, and 5.9% declining bone mineral density. Correlation and regression analysis suggested that percentage changes in BMD were predicted negatively by the preoperative BMD and positively by the preoperative parathyroid mass but not intact PTH levels.
Total parathyroidectomy without autotransplantation could improve BMD of secondary hyperparathyroidism at L1-L4 and the hip. Furthermore, the large parathyroid glandular mass and the preoperative BMD predicted the BMD changes after surgery.
继发性甲状旁腺功能亢进症（SHPT）患者通常存在骨密度降低，这可能导致骨质疏松症、骨折和死亡率显著增加。虽然手术干预对于药物治疗无效的合适患者降低甲状旁腺激素（PTH）水平是有效的，但手术对骨量变化的影响仍需要进一步评估。因此，本研究旨在评估无自体移植的甲状旁腺全切除术（PTX）后骨密度（BMD）变化的特点及其相关因素。
回顾了我院 4 年内成功接受无自体移植的全 PTX 手术且术前和术后均行双能 X 线吸收仪（DEXA）扫描的 34 例患者的记录。采用相关和回归分析来确定独立预测 BMD 变化的因素。
在基线时，我们发现承重腰椎的骨质疏松症患病率似乎明显高于髋部，甚至在不同的腰椎之间差异也很大。SHPT 的骨丢失在承重松质骨中有其倾向部位。在治愈性的无自体移植全 PTX 后，腰椎和髋部的 BMD 总体均显著改善。BMD 增加最大的部位是术前 BMD 最低的 L4 椎体。在受影响最严重的 L4 部位，多达 94.1%的患者的 BMD 得到改善：86.2%的患者有显著改善，5.9%的患者有中度改善，5.9%的患者骨密度下降。相关和回归分析表明，BMD 的百分比变化与术前 BMD 呈负相关，与术前甲状旁腺质量呈正相关，而与完整 PTH 水平无关。
无自体移植的甲状旁腺全切除术可改善继发性甲状旁腺功能亢进症患者的 L1-L4 和髋部的 BMD。此外，大的甲状旁腺腺体质量和术前 BMD 预测了手术后的 BMD 变化。
