无症状原发性甲状旁腺功能亢进症患者的临床特征。
Clinical characteristics of the patients with asymptomatic primary hyperparathyroidism.
机构信息
Department of Endocrinology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038.
Department of Otolaryngology Head and Neck Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038.
出版信息
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2021 Apr 28;46(4):368-372. doi: 10.11817/j.issn.1672-7347.2021.200356.
OBJECTIVES
The prevalence of asymptomatic primary hyperparathyroidism (PHPT) in China is lower than that in European and American countries and the study about the characteristics of asymptomatic PHPT was rare in China. This study aims to explore the characteristics of asymptomatic PHPT.
METHODS
Clinical data of 150 patients with PHPT confirmed by operation and pathological examination were retrospectively analyzed. The patients were assigned into a symptomatic PHPT group (=124) and an asymptomatic PHPT group (=26).
RESULTS
The proportion of adenomas was higher than that of adenocarcinoma in the asymptomatic PHPT group. The proportion of the first diagnosis due to hypercalcemia found via biochemical examination in the asymptomatic PHPT group was higher than that in the symptomatic PHPT group (76.92% vs 25.81%, <0.001). The duration was shorter in the asymptomatic PHPT patients than that in the symptomatic PHPT patients (median 12 months vs 24 months, =0.004). The serum calcium, the albumin-corrected serum calcium, and parathyroid hormone (PTH) were lower in the asymptomatic PHPT patients than those in the symptomatic PHPT (=0.003, =0.006, and =0.042, respectively). The serum 1,25-dihydroxyvitamin D was higher (<0.001), the diameter was shorter (=0.028), and the bone mineral densities (BMD) of L and femoral neck were higher in the asymptomatic PHPT patients than those in the symptomatic PHPT patients (both <0.001).
CONCLUSIONS
Only a minority of PHPT patients are asymptomatic. Compared with the symptomatic PHPT patients, the primary cause of diagnosis is hypercalcemia, the duration of diagnosis and the diameter of parathyroid gland are shorter, the levels of serum calcium, and PTH are lower, the proportion of adenomas, vitamin D, and the BMD of L and femoral neck are higher, and the pathological type is benign in the asymptomatic PHPT patients.
目的
中国无症状原发性甲状旁腺功能亢进症（PHPT）的患病率低于欧美国家，且国内对无症状 PHPT 特征的研究较少。本研究旨在探讨无症状 PHPT 的特征。
方法
回顾性分析 150 例经手术和病理检查证实的 PHPT 患者的临床资料，将患者分为有症状 PHPT 组（n=124）和无症状 PHPT 组（n=26）。
结果
无症状 PHPT 组中腺瘤的比例高于腺癌。无症状 PHPT 组中因生化检查发现高钙血症而首次诊断的比例高于有症状 PHPT 组（76.92%比 25.81%，<0.001）。无症状 PHPT 患者的病程短于有症状 PHPT 患者（中位数 12 个月比 24 个月，=0.004）。无症状 PHPT 患者的血清钙、白蛋白校正血清钙和甲状旁腺激素（PTH）水平低于有症状 PHPT 患者（均<0.001）。血清 1,25-二羟维生素 D 水平较高（<0.001），直径较短（=0.028），L 和股骨颈的骨密度（BMD）较高（均<0.001）。
结论
仅有少数 PHPT 患者无症状。与有症状 PHPT 患者相比，无症状 PHPT 患者的主要诊断原因是高钙血症，诊断病程和甲状旁腺直径较短，血清钙和 PTH 水平较低，腺瘤、维生素 D 和 L 及股骨颈 BMD 的比例较高，且病理类型为良性。
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