Department of Hepatobiliary and Gland Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China (mainland).
Med Sci Monit. 2021 Nov 28;27:e932556. doi: 10.12659/MSM.932556.
BACKGROUND Intraoperative intact parathyroid hormone (IO-iPTH) monitoring has not reached a consensus in predicting surgical outcomes of secondary hyperparathyroidism. Here, we explore the predictive effect of IO-iPTH monitoring on surgical outcomes of secondary hyperparathyroidism as a potentially effective standard. MATERIAL AND METHODS We enrolled 119 patients who underwent total parathyroidectomy with autotransplantation from January 2016 to August 2019. Intact parathyroid hormone (iPTH) levels were tested 1 day before surgery (iPTHpre), 10 min after glands resection (iPTH10min), and 1 and 7 days after the operation (iPTHd1, iPTHd7). According to iPTHpre levels, patients were divided into a <2000 pg/ml group and a ≥2000 pg/ml group, and the cutoff values were compared. In patients with successful parathyroidectomy, the value of iPTHpre minus iPTH10min (iPTHdec) and relative-iPTH10min were compared between groups. RESULTS Using cutoff values, the predictive criterion was defined as iPTH10min ≤314.5 pg/ml or relative-iPTH10min ≤12.4%. In the iPTHpre ≥2000 pg/ml group, iPTH10min had a higher predictive value (318 pg/ml vs 218 pg/ml) whereas relative-iPTH10min had a lower predictive value (12.1% vs 20.3%). In patients with successful PTX, the iPTHdec value of the iPTHpre ≥2000 pg/ml group was significantly higher than that of the <2000 pg/ml group. Additionally, the relative-iPTH10min was significantly lower in the ≥2000 pg/ml group than in the <2000 pg/ml group. CONCLUSIONS An intraoperative predictive criterion of iPTH10min ≤314.5 pg/ml or relative-iPTH10min ≤12.4% is associated with effectively predicting surgical success of secondary hyperparathyroidism. The predictive value is affected by iPTHpre level; therefore, a variable prediction standard based on iPTHpre levels shall be established.
术中完整甲状旁腺激素（IO-iPTH）监测在预测继发性甲状旁腺功能亢进症的手术结果方面尚未达成共识。在这里，我们探讨 IO-iPTH 监测作为一种潜在有效的标准对继发性甲状旁腺功能亢进症手术结果的预测作用。
我们纳入了 2016 年 1 月至 2019 年 8 月期间行甲状旁腺全切除加自体移植术的 119 例患者。在术前 1 天（iPTHpre）、腺体切除后 10 分钟（iPTH10min）以及术后 1 天和 7 天（iPTHd1、iPTHd7）检测完整甲状旁腺激素（iPTH）水平。根据 iPTHpre 水平，将患者分为<2000pg/ml 组和≥2000pg/ml 组，比较两组的截止值。在甲状旁腺切除术成功的患者中，比较 iPTHpre 减去 iPTH10min（iPTHdec）和相对-iPTH10min 在各组之间的差异。
使用截止值，将预测标准定义为 iPTH10min≤314.5pg/ml 或相对-iPTH10min≤12.4%。在 iPTHpre≥2000pg/ml 组中，iPTH10min 具有更高的预测价值（318pg/ml 比 218pg/ml），而相对-iPTH10min 具有更低的预测价值（12.1%比 20.3%）。在甲状旁腺切除术成功的患者中，iPTHpre≥2000pg/ml 组的 iPTHdec 值明显高于 iPTHpre<2000pg/ml 组。此外，iPTHpre≥2000pg/ml 组的相对-iPTH10min 明显低于 iPTHpre<2000pg/ml 组。
iPTH10min≤314.5pg/ml 或相对-iPTH10min≤12.4%的术中预测标准与有效预测继发性甲状旁腺功能亢进症的手术成功相关。预测价值受 iPTHpre 水平的影响；因此，应建立基于 iPTHpre 水平的可变预测标准。
