Division of Endocrine Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
World J Surg. 2023 Aug;47(8):1986-1994. doi: 10.1007/s00268-023-07030-4. Epub 2023 May 4.
In severe renal hyperparathyroidism (RHPT), whether administrating Cinacalcet before total parathyroidectomy can reduce post-operative hypocalcemia remains unclear. We compared post-operative calcium kinetics between those who took Cinacalcet before surgery (Group I) and those who did not (Group II).
Patients with severe RHPT (defined by PTH ≥ 100 pmol/L) who underwent total parathyroidectomy between 2012 and 2022 were analyzed. Standardized peri-operative protocol of calcium and vitamin D supplementation was followed. Blood tests were performed twice daily in the immediate post-operative period. Severe hypocalcemia was defined as serum albumin-adjusted calcium < 2.00 mmol/L.
Among 159 patients who underwent parathyroidectomy, 82 patients were eligible for analysis (Group I, n = 27; Group II, n = 55). Demographics and PTH levels before Cinacalcet administration were comparable (Group I: 169 ± 49 pmol/L vs Group II: 154 ± 45, p = 0.209). Group I had significantly lower pre-operative PTH (77 ± 60 pmol/L vs 154 ± 45, p < 0.001), higher post-operative calcium (p < 0.05), and lower rate of severe hypocalcemia (33.3% vs 60.0%, p = 0.023). Longer duration of Cinacalcet use correlated with higher post-operative calcium levels (p < 0.05). Cinacalcet use for > 1 year resulted in fewer severe post-operative hypocalcemia than non-users (p = 0.022, OR 0.242, 95% CI 0.068-0.859). Higher pre-operative ALP independently correlated with severe post-operative hypocalcemia (OR 3.01, 95% CI 1.17-7.77, p = 0.022).
In severe RHPT, Cinacalcet led to significant drop in pre-operative PTH, higher post-operative calcium levels, and less frequent severe hypocalcemia. Longer duration of Cinacalcet use correlated with higher post-operative calcium levels, and the use of Cinacalcet for > 1 year reduced severe post-operative hypocalcemia.
在严重甲状旁腺功能亢进症（RHPT）中，甲状旁腺全切术前使用西那卡塞是否能降低术后低钙血症仍不清楚。我们比较了术前使用西那卡塞（I 组）和未使用西那卡塞（II 组）的患者术后钙代谢情况。
分析了 2012 年至 2022 年间接受甲状旁腺全切术的严重 RHPT 患者（定义为 PTH≥100pmol/L）。采用标准化的围手术期钙和维生素 D 补充方案。术后即刻每天进行两次血液检查。严重低钙血症定义为血清白蛋白校正钙＜2.00mmol/L。
在 159 例行甲状旁腺切除术的患者中，82 例符合分析条件（I 组，n=27；II 组，n=55）。I 组患者术前甲状旁腺激素（PTH）水平与 II 组无显著差异（I 组：169±49pmol/L 比 II 组：154±45pmol/L，p=0.209）。I 组患者术前 PTH 明显较低（77±60pmol/L 比 154±45pmol/L，p＜0.001），术后血钙较高（p＜0.05），严重低钙血症发生率较低（33.3%比 60.0%，p=0.023）。西那卡塞使用时间较长与术后血钙水平升高相关（p＜0.05）。与非使用者相比，西那卡塞使用＞1 年的患者术后严重低钙血症发生率更低（p=0.022，OR 0.242，95%CI 0.068-0.859）。术前较高的碱性磷酸酶（ALP）水平与术后严重低钙血症独立相关（OR 3.01，95%CI 1.17-7.77，p=0.022）。
在严重甲状旁腺功能亢进症中，西那卡塞可显著降低术前甲状旁腺激素水平，升高术后血钙水平，减少术后严重低钙血症的发生。西那卡塞使用时间较长与术后血钙水平升高相关，使用西那卡塞＞1 年可降低术后严重低钙血症的发生。
