Key Laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Ministry of Health, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Wangfujing, Beijing, 100730, China.
Department of Endocrinology, Hebei General Hospital, Shijiazhuang, 050051, China.
J Endocrinol Invest. 2021 Aug;44(8):1667-1677. doi: 10.1007/s40618-020-01473-5. Epub 2021 Jan 16.
Primary hyperparathyroidism (PHPT) is characterized by excessive secretion of parathyroid hormone (PTH). Vitamin D deficiency can stimulate parathyroid secretion. However, whether to correct vitamin D deficiency in patients with PHPT is controversial. We aimed to evaluate the safety and efficacy of vitamin D replacement in patients with PHPT.
We searched PubMed, Cochrane Library, and Embase. The relevant data were extracted from the included documents. The methodological items for non-randomized studies score entries were used for evaluation of quality. Review Manager 5.3 and Stata 12.0 were used for statistical analysis.
A total of 11 articles were included with a total of 388 patients. The serum calcium mean difference (MD) was - 0.06 mg/dL [95% confidence interval (95% CI) - 0.16, 0.04]. Subgroup analysis showed that serum calcium levels did not change if the intervention time exceeded 1 month. The 24-h urinary calcium MD was 36.78 mg/day (95% CI - 37.15, 110.71), which indicated that there was no significant effect of vitamin D supplementation on 24-h urinary calcium levels. The MD of PTH was - 16.01 pg/mL (95% CI - 28.79, - 3.24). Subgroup analysis according to the intervention time showed that vitamin D intervention for more than 1 month significantly reduced PTH levels. The ALP MD was - 10.81 U/L (95% CI - 13.98, - 7.63), which indicated Vitamin D supplementation reduced its level. The MD of 25-hydroxyvitamin D was 22.09 μg/L (95% CI 15.01, 29.17), and no source of heterogeneity was found.
Vitamin D supplementation in patients with PHPT and vitamin D deficiency significantly reduces PTH and ALP levels without causing hypercalcemia and hypercalciuria.
甲状旁腺功能亢进症（PHPT）的特征是甲状旁腺激素（PTH）过度分泌。维生素 D 缺乏会刺激甲状旁腺分泌。然而，是否纠正 PHPT 患者的维生素 D 缺乏仍存在争议。我们旨在评估 PHPT 患者补充维生素 D 的安全性和疗效。
我们检索了 PubMed、Cochrane Library 和 Embase。从纳入的文献中提取相关数据。使用非随机研究方法学项目评分条目进行质量评估。使用 Review Manager 5.3 和 Stata 12.0 进行统计分析。
共纳入 11 篇文章，共计 388 例患者。血清钙平均差值（MD）为-0.06mg/dL[95%置信区间（95%CI）为-0.16，0.04]。亚组分析显示，如果干预时间超过 1 个月，血清钙水平没有变化。24 小时尿钙 MD 为 36.78mg/天（95%CI-37.15，110.71），表明维生素 D 补充对 24 小时尿钙水平没有显著影响。PTH 的 MD 为-16.01pg/mL（95%CI-28.79，-3.24）。根据干预时间的亚组分析显示，维生素 D 干预超过 1 个月可显著降低 PTH 水平。碱性磷酸酶 MD 为-10.81U/L（95%CI-13.98，-7.63），表明维生素 D 补充可降低其水平。25-羟维生素 D 的 MD 为 22.09μg/L（95%CI 15.01，29.17），未发现异质性来源。
在 PHPT 合并维生素 D 缺乏的患者中补充维生素 D 可显著降低 PTH 和 ALP 水平，而不会导致高钙血症和高钙尿症。
