Elvius M, Lagrelius A, Nygren A, Alveryd A, Christensson T A, Nordenström J
Department of Surgery, Huddinge University Hospital, Sweden.
Eur J Surg. 1995 Dec;161(12):863-9.
To compare the effect of operation and observation on bone mineral mass in patients with mild asymptomatic hyperparathyroidism (HPT).
A randomised 17-year follow-up study.
University hospital, Sweden.
48 women who had been diagnosed as having asymptomatic HPT during a health screening survey in Stockholm, Sweden during 1971-73.
26 patients were operated on and 22 were observed. 46 normocalcaemic women served as a reference population. 17 years later, operated on (n = 12), not operated on (n = 8) and control subjects (n = 16) were followed up.
Bone mineral content (BMC) of distal non-dominant forearm, and serum concentrations of calcium and creatinine.
On entering the study in 1971-73, the BMC of the distal forearm was 14% lower in the patients with HPT than in age, body mass, and postmenopausal age-matched controls (mean (SD) 1.01 (0.23) compared with 1.18 (0.30) g/cm; p < 0.05). During the first 3 years after operation bone mass increased significantly in the group operated on (n = 26) to 106% of the initial values (95% confidence interval (CI) 100% to 111%), remained unchanged (mean 101%; (97% to 106%)) in the unoperated group (n = 22), and decreased significantly to 94% (92% to 97%) of the initial values in the reference group (n = 46). At follow up 17 years later BMC of distal radius in the operated group (n = 12) and patients treated conservatively (n = 8) showed similar values; that were not significantly lower than those of the controls (difference: -12 (18)%).
Our results suggest that patients with mild asymptomatic HPT have already experienced their major bone loss when diagnosed. Parathyroidectomy had an initial positive effect on bone mineralisation, but we could find no long-term advantage in operative treatments. During the 17 year follow-up period HPT patients who were not operated on showed an improvement in bone mass compared with healthy control subjects.
比较手术与观察对轻度无症状甲状旁腺功能亢进症（HPT）患者骨矿物质含量的影响。
一项随机17年随访研究。
瑞典大学医院。
1971年至1973年期间在瑞典斯德哥尔摩的一次健康筛查中被诊断为无症状HPT的48名女性。
26例患者接受手术，22例接受观察。46名血钙正常的女性作为对照人群。17年后，对接受手术的12例、未接受手术的8例以及对照人群的16例进行随访。
非优势侧前臂远端的骨矿物质含量（BMC），以及血清钙和肌酐浓度。
1971年至1973年进入研究时，HPT患者非优势侧前臂远端的BMC比年龄、体重和绝经后年龄匹配的对照组低14%（均值（标准差）为1.01（0.23）g/cm，而对照组为1.18（0.30）g/cm；p<0.05）。术后前3年，接受手术的26例患者的骨量显著增加至初始值的106%（95%置信区间（CI）为100%至111%），未接受手术的22例患者骨量保持不变（均值101%；（97%至106%）），而对照组46例患者的骨量显著下降至初始值的94%（92%至97%）。17年后随访时，手术组（12例）和保守治疗组（8例）桡骨远端的BMC值相似；均不显著低于对照组（差异：-12（18）%）。
我们的结果表明，轻度无症状HPT患者在诊断时已经经历了主要的骨质流失。甲状旁腺切除术对骨矿化有初始积极作用，但我们未发现手术治疗有长期优势。在17年的随访期内，未接受手术的HPT患者与健康对照相比骨量有所改善。
