Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
J Surg Res. 2019 Dec;244:77-83. doi: 10.1016/j.jss.2019.06.020. Epub 2019 Jul 4.
Tertiary hyperparathyroidism (THPT) is characterized by hypercalcemia and hyperparathyroidism after renal allograft. Limited data exist regarding the use of intraoperative parathyroid hormone (IOPTH) for THPT. We examined our series of parathyroidectomies performed for THPT to determine clinical outcomes with respect to IOPTH.
Patients who underwent parathyroidectomy for THPT (1999-2017) were identified for inclusion. Retrospective chart review was performed. Cure was defined as eucalcemia ≥6 mo after surgery. Statistical analysis was performed.
Of 41 patients included in the study, 41% (n = 17) were female. The median duration of dialysis before renal allograft was 34 mo (interquartile interval [IQI]:6-60). Preoperatively, the median calcium level was 10.4 mg/dL (IQI:10.0-11.2), median parathyroid hormone was 172 pg/mL (IQI:104-293), and renal function was minimally abnormal with median glomerular filtration rate 58 mL/min/1.73 m2 (IQI:49-71). At surgery, the median final IOPTH was 40 pg/mL (IQI:29-73), and median decrease in IOPTH was 78% (IQI:72-87), with 88% (n = 36) of patients demonstrating >50% decrease. Median calcium level ≥6 mo after surgery was 9.4 mg/dL (IQI:8.8-9.7), and only one patient had recurrent hypercalcemia. Failure to achieve >50% decrease in IOPTH was not significantly associated with recurrent hypercalcemia (P = 1.000). With a median follow-up time of 41 mo (IQI:25-70), only three patients had graft failure. The positive predictive value of IOPTH for cure was 89% (95% confidence interval: 0.752-0.971), with 0% negative predictive value and 87% accuracy (95% confidence interval: 0.726-0.957).
Subtotal parathyroidectomy is a successful operation with durable cure of THPT. IOPTH fails to predict long-term cure in THPT despite minimally abnormal renal function.
三发性甲状旁腺功能亢进症（THPT）的特征是肾移植后出现高钙血症和甲状旁腺功能亢进。关于术中甲状旁腺激素（IOPTH）在 THPT 中的应用，目前仅有有限的数据。我们检查了我们一系列针对 THPT 进行的甲状旁腺切除术，以确定 IOPTH 的临床结果。
确定了纳入研究的因 THPT 而行甲状旁腺切除术的患者（1999-2017 年）。进行了回顾性图表审查。治愈定义为手术后血钙正常≥6 个月。进行了统计分析。
在纳入研究的 41 例患者中，41%（n=17）为女性。肾移植前透析的中位时间为 34 个月（四分位间距[IQR]：6-60）。术前，中位血钙水平为 10.4mg/dL（IQR：10.0-11.2），中位甲状旁腺激素为 172pg/mL（IQR：104-293），肾小球滤过率轻度异常，中位肾小球滤过率为 58mL/min/1.73m2（IQR：49-71）。在手术中，中位最终 IOPTH 为 40pg/mL（IQR：29-73），IOPTH 中位数降低 78%（IQR：72-87），88%（n=36）的患者降低幅度大于 50%。手术后血钙水平正常≥6 个月的中位数为 9.4mg/dL（IQR：8.8-9.7），仅有 1 例患者出现复发性高钙血症。IOPTH 降低幅度未达到>50%与复发性高钙血症无显著相关性（P=1.000）。中位随访时间为 41 个月（IQR：25-70），仅有 3 例患者发生移植物失败。IOPTH 对治愈的阳性预测值为 89%（95%置信区间：0.752-0.971），阴性预测值为 0%，准确率为 87%（95%置信区间：0.726-0.957）。
甲状旁腺次全切除术是一种成功的手术，可持久治愈三发性甲状旁腺功能亢进症。尽管肾功能轻度异常，IOPTH 仍不能预测 THPT 的长期治愈。
