甲状旁腺最大径作为全甲状旁腺切除术后自体移植依赖性复发性甲状旁腺功能亢进的预测因素。
Maximal parathyroid gland diameter as a predictive factor for autograft-dependent recurrent secondary hyperparathyroidism after total parathyroidectomy.
机构信息
Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.
出版信息
Front Endocrinol (Lausanne). 2023 Jun 15;14:1175237. doi: 10.3389/fendo.2023.1175237. eCollection 2023.
INTRODUCTION
Following total parathyroidectomy (PTx), transcervical thymectomy, and forearm autograft for secondary hyperparathyroidism (SHPT), recurrent SHPT can occur in the autografted forearm. However, few studies have investigated the factors contributing to re-PTx due to autograft-dependent recurrent SHPT before the completion of the initial PTx.
METHODS
A total of 770 patients who had autografted parathyroid fragments derived from only one of the resected parathyroid glands (PTGs) and who had undergone successful initial total PTx and transcervical thymectomy-defined by serum intact parathyroid hormone level < 60 pg/mL on postoperative day 1-between January 2001 and December 2022 were included in this retrospective cohort study. Factors contributing to re-PTx due to graft-dependent recurrent SHPT before the completion of the initial PTx were investigated using multivariate Cox regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to obtain the optimal maximum diameter of PTG for autograft.
RESULTS
Univariate analysis showed that dialysis vintage and maximum diameter and weight of the PTG for autograft were significant factors contributing to graft-dependent recurrent SHPT. However, multivariate analysis revealed that dialysis vintage (=0.010; hazard ratio [HR], 0.995; 95% confidence interval [CI], 0.992-0.999) and the maximum diameter of the PTG for autograft (0.046; HR, 1.107; 95% CI, 1.002-1.224) significantly contributed to graft-dependent recurrent SHPT. ROC curve analysis showed that < 14 mm was the optimal maximum diameter of PTG for autograft (area under the curve, 0.628; 95% CI, 0.551-0.705).
CONCLUSIONS
The dialysis vintage and maximum diameter of PTG for autograft may contribute to re-PTx due to autograft-dependent recurrent SHPT, which can be prevented by using PTGs with a maximum diameter of < 14 mm for autograft.
简介
甲状旁腺全切术（PTx）、经颈胸腺切除术和前臂自体移植治疗继发性甲状旁腺功能亢进症（SHPT）后，自体移植前臂可发生复发性 SHPT。然而，由于初始 PTx 完成前，由于自体移植依赖性复发性 SHPT 而导致再次甲状旁腺切除术的因素很少有研究调查。
方法
本回顾性队列研究纳入了 770 名患者，这些患者仅从切除的甲状旁腺（PTG）之一中移植了甲状旁腺碎片，并且在 2001 年 1 月至 2022 年 12 月期间成功接受了初始全 PTx 和经颈胸腺切除术（定义为术后第 1 天血清完整甲状旁腺激素水平<60pg/mL）。使用多变量 Cox 回归分析研究了导致初始 PTx 完成前由于移植物依赖性复发性 SHPT 而导致再次甲状旁腺切除术的因素。进行了受试者工作特征（ROC）曲线分析，以获得自体移植中 PTG 的最佳最大直径。
结果
单因素分析表明，透析龄和自体移植中 PTG 的最大直径和重量是导致移植物依赖性复发性 SHPT 的重要因素。然而，多因素分析表明，透析龄（=0.010；风险比[HR]，0.995；95%置信区间[CI]，0.992-0.999）和自体移植中 PTG 的最大直径（0.046；HR，1.107；95%CI，1.002-1.224）显著导致移植物依赖性复发性 SHPT。ROC 曲线分析显示，<14mm 是自体移植中 PTG 的最佳最大直径（曲线下面积，0.628；95%CI，0.551-0.705）。
结论
自体移植中 PTG 的透析龄和最大直径可能导致因自体移植依赖性复发性 SHPT 而再次甲状旁腺切除术，通过使用最大直径<14mm 的 PTG 进行自体移植可以预防这种情况。
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