Department of Clinical Medicine, Aarhus University and Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark.
J Clin Endocrinol Metab. 2019 Aug 1;104(8):3223-3232. doi: 10.1210/jc.2018-02456.
It remains unclear whether risk of cardiovascular diseases is increased in patients with mild (<1.45 mmol/L) to moderate (≥1.45 to 1.60 mmol/L) primary hyperparathyroidism (PHPT).
We aimed to determine the short-term effect of parathyroidectomy (PTX) on arterial stiffness, cholesterol levels, and blood pressure (BP).
This study was a clinical trial randomly allocating patients to either PTX or a control group (no surgery). Follow-up was performed 3 months after surgery in the PTX group and 3 months after baseline in the control group.
University hospital.
We recruited 79 patients with PHPT; 69 participants completed the study.
Office and ambulatory 24-hour BP, pulse wave velocity (PWV), augmentation index, and fasting plasma cholesterol levels.
At baseline, participants had a median level of ionized calcium of 1.41 mmol/L (range, 1.33 to 1.60 mmol/L) and PTH of 10.4 pmol/L (4.5 to 30.4 pmol/L). Median age was 64 years (range, 18 to 81) and 72% were females. Following PTX, plasma total cholesterol levels decreased significantly compared with the controls (P = 0.04). Changes in PWV, augmentation index, and ambulatory 24-hour BP did not differ between groups, except for an increase in ambulatory diastolic BP following PTX. However, in patients with baseline levels of ionized calcium ≥1.45 mmol/L, PWV decreased significantly in response to PTX compared with the control group (P = 0.03).
PTX may decrease risk of cardiovascular diseases in PHPT by lowering total cholesterol levels, although ambulatory diastolic BP increases in response to surgery. Patients with moderate to severe hypercalcemia may benefit from PTX by a decrease in PWV.
目前尚不清楚轻度（<1.45mmol/L）至中度（≥1.45 至 1.60mmol/L）原发性甲状旁腺功能亢进症（PHPT）患者的心血管疾病风险是否增加。
我们旨在确定甲状旁腺切除术（PTX）对动脉僵硬度、胆固醇水平和血压（BP）的短期影响。
这是一项临床试验，将患者随机分配至 PTX 组或对照组（无手术）。PTX 组在手术后 3 个月进行随访，对照组在基线后 3 个月进行随访。
大学医院。
我们招募了 79 例 PHPT 患者；69 名参与者完成了研究。
诊室和动态 24 小时血压、脉搏波速度（PWV）、增强指数和空腹血浆胆固醇水平。
在基线时，参与者的离子钙中位数为 1.41mmol/L（范围 1.33 至 1.60mmol/L），PTH 中位数为 10.4pmol/L（4.5 至 30.4pmol/L）。中位年龄为 64 岁（范围 18 至 81），72%为女性。与对照组相比，PTX 后血浆总胆固醇水平显著降低（P=0.04）。两组间 PWV、增强指数和动态 24 小时 BP 的变化无差异，但 PTX 后动态舒张压增加。然而，在基线离子钙水平≥1.45mmol/L 的患者中，与对照组相比，PTX 可使 PWV 显著降低（P=0.03）。
PTX 可能通过降低总胆固醇水平降低 PHPT 患者的心血管疾病风险，尽管手术会导致动态舒张压升高。中度至重度高钙血症患者可能会从 PWV 下降中获益。
