Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai, China.
Front Endocrinol (Lausanne). 2022 Jun 17;13:907019. doi: 10.3389/fendo.2022.907019. eCollection 2022.
BACKGROUND & AIMS: Primary hyperparathyroidism(PHPT) has been evolving into a milder asymptomatic disease. No study has assessed the association between famine exposure and such a shift. We aim to explore the effects of China's Great Famine exposure on the changing pattern of PHPT phenotypes.
750 PHPT patients diagnosed from 2000 to 2019 were studied. The clinical presentations were compared between them in recent 10 years (2010-2019) and previous 10 years (2000-2009). Participants were then categorized into fetal, childhood, adolescent, adult exposure, and unexposed groups. Logistic regression was used to estimate the odds ratios (ORs) and confidence intervals (CIs) of famine exposure as factors contributing to the changes in the clinical presentations of PHPT.
Serum levels of PTH, albumin-corrected Ca, tumor size, eGFR, BMDs (all P<0.001), and clinical symptoms became milder in recent 10 years. Famine exposure (72.6% vs 58.4%, P<0.001), especially the adult exposure (18.8% vs 4.1%, P<0.001)was significant less in recent 10 years. The ORs (95%CIs) of having upper 3 tertile PTH were 2.79(1.34,5.8), 2.07(1.04,4.11), 3.10(1.15,8.38) and 8.85(2.56,30.56) for patients with fetal, childhood, adolescent and adult famine exposure, respectively. The ORs (95%CIs) of upper 3 tertile albumin-corrected Ca and upper 3 tertile of tumor size was 4.78(1.39, 16.38) and 4.07(1.12,14.84) for participants with adult famine exposure, respectively. All these associations were independent of age, sex, disease duration and other confounders.
The clinical manifestations of PHPT in China continue to be milder. Exposure to famine is associated with PHPT. Less famine exposure might be responsible for the mile form of PHPT in recent years.
原发性甲状旁腺功能亢进症（PHPT）已逐渐演变为一种症状较轻的无症状疾病。目前尚无研究评估饥荒暴露与这种转变之间的关系。本研究旨在探讨中国大饥荒暴露对 PHPT 表型变化模式的影响。
研究了 2000 年至 2019 年期间诊断的 750 例 PHPT 患者。比较了他们最近 10 年（2010-2019 年）和前 10 年（2000-2009 年）的临床表现。然后将参与者分为胎儿期、儿童期、青少年期、成年期暴露和未暴露组。采用 logistic 回归估计饥荒暴露作为导致 PHPT 临床表现变化的因素的比值比（ORs）和置信区间（CIs）。
最近 10 年，血清甲状旁腺激素（PTH）、白蛋白校正钙、肿瘤大小、肾小球滤过率（eGFR）和骨密度（BMDs）水平均有所下降（均 P<0.001），临床症状也有所减轻。最近 10 年，饥荒暴露（72.6%比 58.4%，P<0.001），尤其是成年暴露（18.8%比 4.1%，P<0.001）明显减少。胎儿期、儿童期、青少年期和成年期暴露的上 3 分位 PTH 的 OR（95%CI）分别为 2.79（1.34，5.8）、2.07（1.04，4.11）、3.10（1.15，8.38）和 8.85（2.56，30.56）。上 3 分位白蛋白校正钙和上 3 分位肿瘤大小的 OR（95%CI）分别为 4.78（1.39，16.38）和 4.07（1.12，14.84）。这些关联均独立于年龄、性别、病程和其他混杂因素。
中国 PHPT 的临床表现持续减轻。饥荒暴露与 PHPT 有关。近年来，饥荒暴露减少可能是 PHPT 症状减轻的原因。
