Wermers R A, Khosla S, Atkinson E J, Hodgson S F, O'Fallon W M, Melton L J
Mayo Clinic, Rochester, Minnesota, USA.
Ann Intern Med. 1997 Mar 15;126(6):433-40. doi: 10.7326/0003-4819-126-6-199703150-00003.
The introduction of routine measurement of serum calcium levels led to a sharp increase in the incidence of primary hyperparathyroidism in the early 1970s.
To evaluate the trends in the incidence of primary hyperparathyroidism since the mid-1970s.
Rochester and Olmsted County, Minnesota.
Population-based descriptive study.
All residents of Rochester, Minnesota, who received an initial diagnosis of primary hyperparathyroidism between 1965 and 1992 were identified through the medical records linkage system of the Rochester Epidemiology Project. Included as persons having definite cases (92% of the total) were patients with pathologically confirmed hyperparathyroidism, hypercalcemia with inappropriately elevated parathyroid hormone levels, or hypercalcemia that had lasted for more than a year and had no cause other than primary hyperparathyroidism.
Incidence rates were calculated and directly standardized to the population structure of white persons in the United States in 1990.
From 1965 to June 1974 (the prescreening era), the age- and sex-adjusted incidence of primary hyperparathyroidism in Rochester was 15 cases per 100,000 person-years. After measurement of calcium levels was added to the automated serum chemistry panel in July 1974, the incidence increased to 112 per 100,000 person-years in 1975 and then decreased somewhat, reflecting a sweeping effect. Despite improved case ascertainment, however, the incidence rate has continued to decrease; in 1992, the incidence was 4 per 100,000 person-years. A few patients had complications that might have been caused by hyperparathyroidism (22% between 1965 and June 1974 and 6% thereafter), and survival was not impaired in either period. The maximum serum calcium levels did not change (P = 0.15).
The progressive decrease in the incidence of primary hyperparathyroidism is unexpected and suggests a significant change in the epidemiology of this disease.
20世纪70年代初，血清钙水平常规检测的引入导致原发性甲状旁腺功能亢进症的发病率急剧上升。
评估20世纪70年代中期以来原发性甲状旁腺功能亢进症的发病率趋势。
明尼苏达州罗切斯特市和奥尔姆斯特德县。
基于人群的描述性研究。
通过罗切斯特流行病学项目的医疗记录链接系统，确定了1965年至1992年间首次诊断为原发性甲状旁腺功能亢进症的明尼苏达州罗切斯特市所有居民。确诊病例（占总数的92%）包括病理确诊的甲状旁腺功能亢进症患者、甲状旁腺激素水平异常升高伴高钙血症的患者，或持续一年以上且无原发性甲状旁腺功能亢进症以外病因的高钙血症患者。
计算发病率，并直接标准化为1990年美国白人的人口结构。
1965年至1974年6月（筛查前时代），罗切斯特市经年龄和性别调整的原发性甲状旁腺功能亢进症发病率为每10万人年15例。1974年7月钙水平检测被添加到自动血清化学检测项目中后，1975年发病率增至每10万人年112例，随后有所下降，这反映了一种全面影响。然而，尽管病例确诊有所改善，但发病率仍持续下降；1992年，发病率为每10万人年4例。少数患者出现了可能由甲状旁腺功能亢进症引起的并发症（1965年至1974年6月期间为22%，此后为6%），两个时期的生存率均未受损。血清钙最高水平没有变化（P = 0.15）。
原发性甲状旁腺功能亢进症发病率的逐渐下降出乎意料，表明该疾病的流行病学发生了重大变化。
