Wermers R A, Khosla S, Atkinson E J, Grant C S, Hodgson S F, O'Fallon W M, Melton L J
Division of Endocrinology/Metabolic Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Am J Med. 1998 Feb;104(2):115-22. doi: 10.1016/s0002-9343(97)00270-2.
Reports of increased mortality from cardiovascular disease and malignancy in primary hyperparathyroidism have been based primarily on patients who have undergone parathyroidectomy. In order to assess the true impact of primary hyperthyroidism on mortality in the general population, we assessed survival in a large inception cohort of Rochester, Minnesota residents with primary hyperparathyroidism initially diagnosed over a 28-year span, the majority of whom were followed with uncomplicated disease.
All Rochester residents with primary hyperparathyroidism first recognized in 1965 to 1992 were identified through the Rochester Epidemiology Project medical records linkage system. Included as cases were patients with pathologic confirmation of hyperthyroidism, hypercalcemia with inappropriately elevated parathyroid hormone levels, or hypercalcemia for more than a year with no other cause. Survival was estimated using the Kaplan Meier product-limit method. The Cox proportional hazards model was used to determine associations, as relative hazards (RR) with 95% confidence intervals (CI), of various risk factors with time to death.
During the study period, 435 cases of primary hyperparathyroidism were identified. Altogether, parathyroid surgery was performed on 126 patients (29%), with a mean delay between the initial elevated serum calcium level and surgery of 3.3 years. Patients who underwent surgery had higher maximum serum calcium levels than the patients who were observed (mean+/-SD, 11.3+/-0.7 versus 10.7+/-0.4 mg/dL, P <0.00 1), but their mean ages were similar (54+/-16 versus 56+/-17 years). Overall survival in the patients with primary hyperthyroidism was better than expected (P=0.02), but by age-adjusted multivariate analysis, higher maximal serum calcium level was an independent predictor of mortality (RR=1.3 per mg/dL; 95% CI: 1.1-1.6; P <0.02).
Overall survival is not adversely affected among unselected patients with mild primary HPT in the community, although patients with more severe disease, as manifested by higher serum calcium levels, may have an increased risk of death.
原发性甲状旁腺功能亢进症患者心血管疾病和恶性肿瘤死亡率增加的报告主要基于接受甲状旁腺切除术的患者。为了评估原发性甲状旁腺功能亢进症对普通人群死亡率的真正影响，我们评估了明尼苏达州罗切斯特市一个大型起始队列中最初在28年期间被诊断为原发性甲状旁腺功能亢进症的居民的生存率，其中大多数患者的疾病病情不复杂。
通过罗切斯特流行病学项目医疗记录链接系统识别出所有在1965年至1992年首次确诊为原发性甲状旁腺功能亢进症的罗切斯特居民。病例包括甲状旁腺功能亢进症经病理证实、血钙升高且甲状旁腺激素水平异常升高或血钙升高超过一年且无其他病因的患者。使用Kaplan-Meier乘积限法估计生存率。Cox比例风险模型用于确定各种风险因素与死亡时间的关联，以相对风险（RR）及95%置信区间（CI）表示。
在研究期间，共识别出435例原发性甲状旁腺功能亢进症病例。总共有126例患者（29%）接受了甲状旁腺手术，从最初血清钙水平升高到手术的平均延迟时间为3.3年。接受手术的患者的最高血清钙水平高于接受观察的患者（均值±标准差，分别为(11.3±0.7)与(10.7±0.4)mg/dL，P<0.001），但他们的平均年龄相似（分别为(54±16)与(56±17)岁）。原发性甲状旁腺功能亢进症患者的总体生存率优于预期（P = 0.02），但经年龄调整的多变量分析显示，最高血清钙水平是死亡率的独立预测因素（RR = 每mg/dL为1.3；95%CI：1.1 - 1.6；P<0.02）。
社区中未经选择的轻度原发性甲状旁腺功能亢进症患者的总体生存率未受到不利影响，尽管血清钙水平较高所表现出的病情较严重的患者可能有更高的死亡风险。
