Johnson W J, McCarthy J T, van Heerden J A, Sterioff S, Grant C S, Kao P C
Division of Nephrology, Mayo Clinic, Rochester, Minnesota 59905.
Am J Med. 1988 Jan;84(1):23-32. doi: 10.1016/0002-9343(88)90004-6.
In 61 hemodialysis patients undergoing subtotal parathyroidectomy, there was a good correlation between the preoperative serum immunoreactive parathyroid hormone value (iPTH) and the weight of parathyroid tissue removed surgically (p less than or equal to 0.001). Postoperatively, iPTH decreased rapidly from an initial mean (+/- SD) of 2,928 +/- 1,600 muleq/ml and remained at 365 +/- 296 muleq/ml at last follow-up of patients still undergoing hemodialysis (normal, less than 50 muleq/ml). Of six patients who had recurrent hyperparathyroidism (10 percent of total), three required a second subtotal parathyroidectomy. Aluminum-related osteomalacia eventually developed in six patients with bone biopsy-proven hyperparathyroidism before parathyroidectomy. Nine patients with severe fracturing bone disease and hypercalcemia preoperatively but without clear evidence of hyperparathyroidism did not show a favorable response to subtotal parathyroidectomy (high mortality within 28 months, persistence of hypercalcemia, and symptomatic bone disease). Thus, subtotal parathyroidectomy can benefit patients with clearly established severe progressive hyperparathyroidism not responsive to medical therapy but is contraindicated in patients with low iPTH values and no bone biopsy evidence of severe hyperparathyroidism.
在61例接受甲状旁腺次全切除术的血液透析患者中，术前血清免疫反应性甲状旁腺激素值（iPTH）与手术切除的甲状旁腺组织重量之间存在良好的相关性（p≤0.001）。术后，iPTH从最初的平均（±标准差）2,928±1,600 mEq/ml迅速下降，在仍接受血液透析的患者的最后一次随访中保持在365±296 mEq/ml（正常范围，低于50 mEq/ml）。在6例复发性甲状旁腺功能亢进患者（占总数的10%）中，3例需要进行第二次甲状旁腺次全切除术。6例在甲状旁腺切除术前经骨活检证实为甲状旁腺功能亢进的患者最终发生了铝相关性骨软化症。9例术前患有严重骨折性骨病和高钙血症但无明确甲状旁腺功能亢进证据的患者对甲状旁腺次全切除术未显示出良好反应（28个月内死亡率高、高钙血症持续存在且有症状性骨病）。因此，甲状旁腺次全切除术对明确诊断为严重进行性甲状旁腺功能亢进且对药物治疗无反应的患者有益，但对iPTH值低且无骨活检证据显示严重甲状旁腺功能亢进的患者禁用。
