Magriñá-Mercado Roser M, Ramírez-Rentería Claudia, Almeida-Gutiérrez Eduardo, Mendoza-Zubieta Victoria, Ferreira-Hermosillo Aldo
Servicio de Endocrinología. Hospital de Especialidades Centro Médico Nacional Siglo XXI. Ciudad de México, México.
Unidad de Investigación en Endocrinología Experimental. Hospital de Especialidades Centro Médico Nacional Siglo XXI. Ciudad de México, México.
Cir Cir. 2019;87(2):196-204. doi: 10.24875/CIRU.18000520.
Primary hyperparathyroidism (PHPT) is the leading cause of outpatient hypercalcemia associated with increased cardiovascular risk. The flow-mediated vasodilation (FMV) has been proposed as a non-invasive method for assessing endothelial function.
To compare the endothelial dysfunction measured by FMV and diastolic dysfunction in patients with PHPT before and after parathyroidectomy.
We performed a quasi-experimental (before-after) study to evaluate diastolic function and FMV in patients with PHPT before and six months after parathyroidectomy.
Fifteen patients completed study: 12 women and 3 men; 73% presented lithiasis, 27% osteoporosis and 53% metabolic syndrome; 73% presented diastolic dysfunction before the surgery and 60% after the surgery (p = 0.09). Post-isquemia brachial diameter improved from 41 mm (before surgery) to 46 mm (after surgery; p = 0.020). After surgery, we also observed an increase in the brachial diameter pre vs. post-ischemia from 41 to 46 mm (p = 0.005). Before surgery, the change in the delta of brachial diameter pre and post-ischemia was 1 mm and up to 4 mm after surgery (p = 0.03).
There is a minor endothelial dysfunction measured by FMV in patients who underwent surgery for PHPT at 6 months after surgery, as well as a trend towards improvement in diastolic dysfunction. Echocardiography can be useful in the preoperative evaluation in patients with asymptomatic PHPT.
原发性甲状旁腺功能亢进症（PHPT）是门诊高钙血症的主要病因，且与心血管风险增加相关。血流介导的血管舒张（FMV）已被提议作为评估内皮功能的一种非侵入性方法。
比较甲状旁腺切除术前和术后PHPT患者通过FMV测量的内皮功能障碍和舒张功能障碍。
我们进行了一项准实验性（前后对照）研究，以评估PHPT患者在甲状旁腺切除术前和术后6个月的舒张功能和FMV。
15名患者完成了研究，其中12名女性和3名男性；73%有结石，27%有骨质疏松症，53%有代谢综合征；73%在手术前存在舒张功能障碍，术后为60%（p = 0.09）。缺血后肱动脉直径从41毫米（手术前）改善至46毫米（手术后；p = 0.020）。手术后，我们还观察到缺血前后肱动脉直径从41毫米增加到46毫米（p = 0.005）。手术前，缺血前后肱动脉直径变化差值为1毫米，手术后增至4毫米（p = 0.03）。
接受PHPT手术的患者在术后6个月通过FMV测量存在轻微的内皮功能障碍，舒张功能障碍也有改善趋势。超声心动图在无症状PHPT患者的术前评估中可能有用。
