永久性术后甲状旁腺功能减退症：对260例患者队列中患病率及控制充分性的预测因素分析
Permanent postoperative hypoparathyroidism: an analysis of prevalence and predictive factors for adequacy of control in a cohort of 260 patients.
作者信息
Díez Juan J, Anda Emma, Sastre Julia, Pérez Corral Begoña, Álvarez-Escolá Cristina, Manjón Laura, Paja Miguel, Sambo Marcel, Santiago Fernández Piedad, Blanco Carrera Concepción, Galofré Juan C, Navarro Elena, Zafón Carles, Sanz Eva, Oleaga Amelia, Bandrés Orosia, Donnay Sergio, Megía Ana, Picallo María, Sánchez Ragnarsson Cecilia, Baena-Nieto Gloria, Fernández-García José Carlos, Lecumberri Beatriz, Sahún de la Vega Manel, Romero-Lluch Ana R, Iglesias Pedro
机构信息
Department of Endocrinology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Present address: Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Madrid, Spain.
出版信息
Gland Surg. 2020 Oct;9(5):1380-1388. doi: 10.21037/gs-20-288.
BACKGROUND
Recent guidelines for the treatment of hypoparathyroidism emphasize the need for long-term disease control, avoiding symptoms and hypocalcaemia. Our aim has been to analyze the prevalence of poor disease control in a national cohort of patients with hypoparathyroidism, as well as to evaluate predictive variables of inadequate disease control.
METHODS
From a nation-wide observational study including a cohort of 1792 patients undergoing total thyroidectomy, we selected 260 subjects [207 women and 53 men, aged (mean ± SD) 47.2±14.8 years] diagnosed with permanent hypoparathyroidism. In every patient demographic data and details on surgical procedure, histopathology, calcium (Ca) metabolism, and therapy with Ca and calcitriol were retrospectively collected. A patient was considered not adequately controlled (NAC) if presented symptoms of hypocalcemia or biochemical data showing low serum Ca levels or high urinary Ca excretion.
RESULTS
Two hundred and twenty-one (85.0%) patients were adequately controlled (AC) and 39 (15.0%) were NAC. Comparison between AC and NAC patients did not show any significant difference in demographic, surgical, and pathological features. Rate of hospitalization during follow-up was significantly higher among NAC patients in comparison with AC patients (35.9% . 10.9%, P<0.001). Dose of oral Ca and calcitriol were also significantly higher in NAC subjects. In a subgroup of 129 patients with serum parathyroid hormone (PTH) levels available, we found that NAC patients exhibited significantly lower postoperative PTH concentrations than AC patients [median (interquartile range) 3 (1.9-7.8) . 6.9 (3.0-11) pg/mL; P=0.009].
CONCLUSIONS
In a nation-wide cohort of 260 subjects with definitive hypoparathyroidism, 15% of them had poor disease control. These patients required higher doses of oral Ca and calcitriol, had higher rate of hospitalization during follow-up and showed lower PTH concentrations in the postoperative period.
背景
近期甲状旁腺功能减退症的治疗指南强调了长期疾病控制的必要性，以避免出现症状和低钙血症。我们的目的是分析全国甲状旁腺功能减退症患者队列中疾病控制不佳的患病率，并评估疾病控制不足的预测变量。
方法
在一项全国性观察性研究中，纳入了1792例行全甲状腺切除术的患者队列，我们从中选取了260例确诊为永久性甲状旁腺功能减退症的患者[207例女性和53例男性，年龄（均值±标准差）为47.2±14.8岁]。回顾性收集了每位患者的人口统计学数据以及手术过程、组织病理学、钙（Ca）代谢以及钙剂和骨化三醇治疗的详细信息。如果患者出现低钙血症症状或生化数据显示血清钙水平低或尿钙排泄高，则认为该患者疾病控制不佳（NAC）。
结果
221例（85.0%）患者疾病控制良好（AC），39例（15.0%）为疾病控制不佳（NAC）。AC组和NAC组患者在人口统计学、手术和病理特征方面未显示出任何显著差异。与AC组患者相比，NAC组患者随访期间的住院率显著更高（35.9%对10.9%，P<0.001）。NAC组患者的口服钙剂和骨化三醇剂量也显著更高。在一个有血清甲状旁腺激素（PTH）水平数据的129例患者亚组中，我们发现NAC组患者术后PTH浓度显著低于AC组患者[中位数（四分位间距）为3（1.9 - 7.8）对6.9（3.0 - 11）pg/mL；P = 0.009]。
结论
在一个全国性的260例确诊甲状旁腺功能减退症患者队列中，15%的患者疾病控制不佳。这些患者需要更高剂量的口服钙剂和骨化三醇，随访期间住院率更高，且术后PTH浓度更低。
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