Frye C Corbin, Sanka Sai Anusha, Sullivan Janessa, Brunt L Michael, Gillanders William E, Pandian T K, Brown Taylor C
Department of Surgery, Section of Surgical Oncology, Washington University School of Medicine, Saint Louis, Missouri; Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, Missouri.
Department of Surgery, Section of Surgical Oncology, Washington University School of Medicine, Saint Louis, Missouri.
J Surg Res. 2023 Aug;288:148-156. doi: 10.1016/j.jss.2023.02.011. Epub 2023 Mar 24.
Preoperative differentiation of single-gland (SG) versus multigland (MG) primary hyperparathyroidism (PHPT) can assist with surgical planning, treatment prognostication, and patient counseling. The aim of this study was to identify preoperative predictors of SG-PHPT.
Retrospective analysis of 408 patients with PHPT who underwent parathyroidectomy at a tertiary referral center. Comprehensive preoperative parameters, including demographic, laboratory, clinical, and imaging results were analyzed. Univariate analysis and binary logistic regression identified preoperative predictors of SG-PHPT. Receiver operator curves were used to analyze the predictive values of existing and novel preoperative predictive models.
Elevated parathyroid hormone (PTH) (99.1 pg/mL in SG versus 93.0 pg/mL in MG), elevated calcium (10.8 mg/dL in SG versus 10.6 mg/dL in MG), lower phosphate levels (2.80 mg/dL in SG versus 2.95 mg/dL in MG), and positive imaging (ultrasound 75.6% in SG versus 56.5% in MG; sestamibi 70.8% in SG versus 45.5% in MG) were significantly associated with SG-PHPT. The Washington University Score (a predictive scoring system made from calcium, PTH, phosphate, ultrasound, and sestamibi) and the Washington University Index ([calcium × PTH]/phosphate) were comparable to previous scoring systems used to predict SG versus MG-PHPT.
The association of lower phosphate with SG-PHPT is a novel finding. Previously identified predictors of SG-PHPT, including elevated PTH and positive imaging were confirmed. The Washington University Score and Index are comparable to previously described models and can be used to help surgeons predict if a patient may have SG versus MG-PHPT.
术前区分单发性甲状旁腺（SG）与多发性甲状旁腺（MG）原发性甲状旁腺功能亢进症（PHPT）有助于手术规划、治疗预后评估及患者咨询。本研究旨在确定SG-PHPT的术前预测指标。
对在一家三级转诊中心接受甲状旁腺切除术的408例PHPT患者进行回顾性分析。分析了包括人口统计学、实验室检查、临床及影像学结果在内的全面术前参数。单因素分析和二元逻辑回归确定了SG-PHPT的术前预测指标。采用受试者操作特征曲线分析现有及新的术前预测模型的预测价值。
甲状旁腺激素（PTH）升高（SG组为99.1 pg/mL，MG组为93.0 pg/mL）、血钙升高（SG组为10.8 mg/dL，MG组为10.6 mg/dL）、血磷水平降低（SG组为2.80 mg/dL，MG组为2.95 mg/dL）以及影像学检查阳性（超声检查SG组为75.6%，MG组为56.5%；锝[99mTc]甲氧基异丁基异腈扫描SG组为70.8%，MG组为45.5%）与SG-PHPT显著相关。华盛顿大学评分（一种由血钙、PTH、血磷、超声及锝[99mTc]甲氧基异丁基异腈扫描得出的预测评分系统）和华盛顿大学指数（[血钙×PTH]/血磷）与先前用于预测SG与MG-PHPT的评分系统相当。
血磷降低与SG-PHPT的关联是一项新发现。先前确定的SG-PHPT预测指标，包括PTH升高及影像学检查阳性得到了证实。华盛顿大学评分和指数与先前描述的模型相当，可用于帮助外科医生预测患者可能患有SG还是MG-PHPT。
