尿钙排泄与钙/肌酐清除率比值在家族性低尿钙性高钙血症与原发性甲状旁腺功能亢进症鉴别诊断中的作用。
Efficacy of calcium excretion and calcium/creatinine clearance ratio in the differential diagnosis of familial hypocalciuric hypercalcemia and primary hyperparathyroidism.
机构信息
Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
出版信息
Head Neck. 2019 May;41(5):1372-1378. doi: 10.1002/hed.25568. Epub 2018 Dec 15.
BACKGROUND
Twenty-four-hour renal calcium-excretion (CE) and calcium/creatinine-clearance-ratio (CCCR), respectively, are widely used to rule out familial hypocalciuric hypercalcemia (FHH) in patients with suspected primary hyperparathyroidism before surgery. The aim was to evaluate the practicability of CE compared to CCCR.
PATIENTS AND METHODS
We analyzed biochemical parameters, surgical treatment, gene mutation results, and long-term follow-up data of 198 patients (including 14 patients with FHH) and the discriminative power of CE and CCCR.
RESULTS
Twenty four patients (12.1%) had a low CE and 35 patients (20.2%) had a CCCR indicating FHH. However, eight patients with FHH (57.1%) had a normal or increased CE. Correspondingly, only eight cases of FHH (57.1%) were correctly predicted by CCCR. Sensitivity/specificity were 42.9%/89.9% for CE and 64.3%/79.9% for CCCR, showing no statistical differences (P = 0.482) between both methods.
CONCLUSION
Neither CE nor CCCR was able to distinguish between PHPT and FHH but may help to narrow down potential FHH patients.
背景
二十四小时肾钙排泄（CE）和钙/肌酐清除率比值（CCCR）分别广泛用于在手术前排除疑似原发性甲状旁腺功能亢进症患者的家族性低钙尿性高钙血症（FHH）。目的是评估 CE 与 CCCR 的实用性。
患者和方法
我们分析了 198 名患者（包括 14 名 FHH 患者）的生化参数、手术治疗、基因突变结果和长期随访数据，以及 CE 和 CCCR 的鉴别能力。
结果
24 名患者（12.1%）CE 低，35 名患者（20.2%）CCCR 提示 FHH。然而，8 名 FHH 患者（57.1%）CE 正常或升高。相应地，仅 8 例 FHH（57.1%）被 CCCR 正确预测。CE 的敏感性/特异性为 42.9%/89.9%，CCCR 为 64.3%/79.9%，两种方法之间无统计学差异（P=0.482）。
结论
CE 和 CCCR 均不能区分 PHPT 和 FHH，但可能有助于缩小潜在 FHH 患者的范围。
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