Department of Medical Sciences, University of Trieste, Trieste, Italy.
Operative Unit of Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Hospital, Trieste, Italy.
J Clin Endocrinol Metab. 2021 May 13;106(6):1832-1843. doi: 10.1210/clinem/dgab157.
Current data about the cardiovascular manifestations of mild primary hyperparathyroidism (pHPT) are often conflicting. Pulse wave velocity (PWV) is the gold standard for assessing aortic stiffness, and it predicts cardiovascular morbidity and mortality.
Primary outcomes were to investigate if mild pHPT was associated with higher PWV and if parathyroidectomy (PTX) reduced PWV in mild pHPT. Secondary outcome was to investigate blood pressure changes after PTX.
Sources were PubMed, Google Scholar, SCOPUS, Web of Science, and the Cochrane Library. Eligible studies included reports of PWV in patients with mild pHPT and controls, or in patients with mild pHPT before and after PTX. Two investigators independently identified eligible studies and extracted data. Pooled mean difference (MD) was the summary effect measure. Data were presented in forest plots with outlier and influential case diagnostics. Nine observational studies and one randomized clinical trial were selected, including 433 patients with mild pHPT, 171 of whom underwent PTX, and 407 controls. PWV was significantly higher in mild pHPT than in controls (MD = 1.18, 0.67 to 1.68, P < .0001). Seven studies evaluated the effect of PTX on PWV. PTX significantly reduced PWV (MD = -0.48, -0.88 to -0.07, P = .022).
Aortic stiffness is increased in patients with mild pHPT, supporting the notion that mild pHPT is also associated with adverse cardiovascular manifestations. PTX significantly reduced arterial stiffness in mild pHPT, indicating that the benefit of PTX over cardiovascular manifestations should not be dismissed but it deserves further studies.
目前关于轻度原发性甲状旁腺功能亢进症（pHPT）的心血管表现的数据常常相互矛盾。脉搏波速度（PWV）是评估主动脉僵硬度的金标准，它可预测心血管发病率和死亡率。
主要结局是研究轻度 pHPT 是否与较高的 PWV 相关，以及甲状旁腺切除术（PTX）是否降低轻度 pHPT 中的 PWV。次要结局是研究 PTX 后血压的变化。
检索PubMed、Google Scholar、SCOPUS、Web of Science 和 Cochrane Library。纳入研究报告了轻度 pHPT 患者与对照组、或轻度 pHPT 患者在 PTX 前后的 PWV。两名研究者独立确定了合格的研究并提取数据。汇总均数差（MD）是总结效应量。数据以森林图表示，并用异常值和有影响的病例诊断进行分析。选择了 9 项观察性研究和 1 项随机临床试验，共纳入 433 例轻度 pHPT 患者，其中 171 例接受了 PTX，407 例为对照组。轻度 pHPT 患者的 PWV 明显高于对照组（MD=1.18，0.67 至 1.68，P＜0.0001）。有 7 项研究评估了 PTX 对 PWV 的影响。PTX 显著降低了 PWV（MD=-0.48，-0.88 至-0.07，P=0.022）。
轻度 pHPT 患者的主动脉僵硬度增加，支持轻度 pHPT 也与不良心血管表现相关的观点。PTX 显著降低了轻度 pHPT 中的动脉僵硬度，表明 PTX 对心血管表现的益处不应被忽视，但还需要进一步的研究。
