甲状旁腺切除术后甲状旁腺特征对持续性继发性甲状旁腺功能亢进的预测价值。
Predictive value of characteristics of resected parathyroid glands for persistent secondary hyperparathyroidism during parathyroidectomy.
机构信息
Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
出版信息
BMC Surg. 2023 Feb 14;23(1):36. doi: 10.1186/s12893-023-01936-5.
BACKGROUND
Parathyroidectomy (PTX), an effective treatment for refractory secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) patients, still has a high persistent rate. This study aimed to analyze the predictive value of characteristics of resected parathyroid glands for postoperative persistent SHPT.
METHODS
The clinical data of patients with persistent SHPT and successful PTX controls who had or underwent total parathyroidectomy with forearm autotransplantation (TPTX + AT) was retrospectively collected. The characteristics including the number, minimum weight, maximum weight and total weight of resected parathyroid glands from each patient were recorded. Characteristics and cutoff value of resected parathyroid glands for the prediction of persistent SHPT were analyzed.
RESULTS
A total of 227 patients (62 persistent SHPT patients and 165 successful PTX controls) were enrolled in the study. Forty-one (66%) persistent SHPT cases related to supernumerary parathyroid and the remaining 21 (34%) cases related to residual undetected parathyroid. In addition, ectopic parathyroid was found in 8 patients (13%) before PTX. The average number of resected glands in the persistent SHPT group and successful PTX group was 3.53 ± 0.72 and 3.93 ± 0.25 respectively (p < 0.001). There was significance in the number of patients with different resected parathyroid glands between two groups (p < 0.001). When the resected gland number was 4, minimum weight of the parathyroid was noted to be heavier in the persistent SHPT group than that in the successful PTX group (0.52 ± 0.31 g vs. 0.38 ± 0.19 g, p < 0.001). For persistent SHPT prediction, cutoff value of minimum weight was 0.535 g, with sensitivity of 46% and specificity of 82% (AUC = 0.611; p = 0.029).
CONCLUSIONS
Major reason for the persistent SHPT is the existence of supernumerary parathyroid glands or resection of less than 4 glands. When 4 glands were resected, a minimum total parathyroid gland weight heavier than 0.535 g implied the potential presence of a missed supernumerary parathyroid gland, which also contributed to the persistent SHPT.
背景
甲状旁腺切除术（PTX）是治疗慢性肾脏病（CKD）患者难治性继发性甲状旁腺功能亢进症（SHPT）的有效方法，但术后仍有较高的持续性。本研究旨在分析切除甲状旁腺的特征对术后持续性 SHPT 的预测价值。
方法
回顾性收集接受全甲状旁腺切除术加前臂自体移植（TPTX+AT）的持续性 SHPT 患者和成功 PTX 对照患者的临床资料。记录每位患者切除甲状旁腺的数量、最小重量、最大重量和总重量等特征。分析切除甲状旁腺的特征及其对持续性 SHPT 的预测价值。
结果
共纳入 227 例患者（62 例持续性 SHPT 患者和 165 例成功 PTX 对照组）。41 例（66%）持续性 SHPT 与甲状旁腺增生有关，其余 21 例（34%）与残留未发现的甲状旁腺有关。此外，8 例患者（13%）在 PTX 前发现异位甲状旁腺。持续性 SHPT 组和成功 PTX 组切除的甲状旁腺数量平均分别为 3.53±0.72 和 3.93±0.25（p<0.001）。两组间切除甲状旁腺的患者数量存在显著差异（p<0.001）。当切除的甲状旁腺数量为 4 个时，持续性 SHPT 组的甲状旁腺最小重量比成功 PTX 组更重（0.52±0.31 g 比 0.38±0.19 g，p<0.001）。对于持续性 SHPT 的预测，最小重量的截断值为 0.535 g，其敏感性为 46%，特异性为 82%（AUC=0.611；p=0.029）。
结论
持续性 SHPT 的主要原因是存在甲状旁腺增生或切除少于 4 个甲状旁腺。当切除 4 个甲状旁腺时，如果甲状旁腺总重量小于 0.535 g，则暗示可能存在遗漏的甲状旁腺增生，这也可能导致持续性 SHPT。
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