无症状型原发性甲状旁腺功能亢进症临床特点分析  

The clinical characteristics of asymptomatic primary hyperparathyroidism in Peking Union Medical College Hospital

作　　者：王鸥[1] 邢小平[1] 孟迅吾[1] 夏维波[1] 李梅[1] 姜艳[1] 韩桂艳[1] 胡莹莹[1] 刘怀成[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院内分泌科卫生部内分泌重点实验室,北京100730

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2010年第1期18-22,共5页Chinese Journal Of Osteoporosis And Bone Mineral Research

摘　　要：目的随着血钙水平筛查的普及,西方国家原发性甲状旁腺功能亢进症(PHPT)的多数患者表现为无症状型或轻症HPT(aPHPT),而国内文献报告的PHPT患者大多具有典型临床表现。本研究旨在通过分析北京协和医院诊断的无症状型PHPT患者的临床资料,总结我院无症状型PHPT的特点。方法 1958年～2006年5月在北京协和医院经生化检查、手术病理证实的散发性PHPT患者278例,参照NIH共识标准,其中18例诊断为aPHPT,与260例经典型PHPT(cPHPT)患者进行比较。病历资料采用回顾性分析。测定PHPT患者的血总钙(TCa)、游离钙(ICa)、磷(P)、碱性磷酸酶(AKP)、甲状旁腺素(PTH)、及24小时尿Ca、P水平,部分患者采用DXA测定腰椎、股骨上段骨密度(BMD)。采用SPSS11.5软件进行统计分析。结果 (1)一般情况及生化指标:aPHPT组年龄(54.2±18.8岁)大于cPHPT组(41.1±15.1岁),P=0.001。aPHPT组及cPHPT组术前血AKP中位数分别为96.0(79.3,335.8)IU/L和467.5(197.0,1121.7)IU/L,有显著差异(P<0.001),其他生化指标在两组间未发现显著性差异。(2)骨密度:aPHPT组(n=8)L_(2-4) BMD的T值、Z值分别为-1.35±1.78和-0.74±1.28,cPHPT组(n=89)L_(2-4) BMD的T值、Z值分别为-2.74±1.48和-1.97±1.68,均有显著性差异(P=0.014,0.047)。(3)手术结果:aPHPT组中11例(61.1%)为腺瘤,7例(38.9%)为增生,均为良性病变;cPHPT组中197例(75.8%)为腺瘤,44例(16.9%)为增生,19例(7.3%)为腺癌,两组分布有显著差异(P=0.013)。aPHPT组、cPHPT组肿瘤直径分别为2.24±1.12cm和2.82±1.20cm,P=0.050。结论与经典型PHPT相比较,我院的无症状型PHPT患者诊断年龄较大,术前血AKP水平升高、腰椎骨密度降低不如经典HPT明显,病变甲状旁腺直径较小,病理类型均为良性且增生比例较高。无症状PHPT患者中大部分存在骨量减少甚至骨质疏松,但需要更大的样本量进一步研究。Objective In western countries where the multichannel screening of serum calcium is readily availa- ble, most of the patients of primary hyperparathyroidism （PHPT） present asymptomatic （aPHPT）. In this study, we ana- lyzed the clinical data of asymptomatic PHPT patients diagnosed in Peking Union Medical College Hospital （PUMCH） to summarize their clinical characteristics. Methods From 1958 to 2006, 278 patients were diagnosed as sporadic PHPT according to biochemical markers and pathology, among which 18 cases were classified as asyrnptomatic PHPT （aPHPT） based on NIH consensus. The clinical data of patients of aPHPT and classical PHPT （cPHPT） was retrospectively ana- lyzed. The biochemical markers including blood TCa, ICa, P, AKP, PTH and 24h urinay Ca, P levels were measured. BMD of L2-4 and proximal femurs was measured by DXA. SPSS 11.5 software were used for statistical analysis. Results （ 1 ） The age of diagnosis was significantly older in aPHPT than cPHPT patients （54. 2± 18.8 years vs 41.1± 15.1 years, P = 0. 001 ）. The pre-surgical serum AKP levels were significantly higher in cPHPT group than in aPHPT group （ median 96. 0IU/L vs 467.5IU/L, P 〈 0. 001 ）. The T-scores （ - 2. 74 ± 1.48 vs - 1.35 ± 1.78, P -- 0. 014 ） and Z- scores （ - 1.97 ± 1.68 vs - O. 74 ± 1.28, P = 0. 047 ） of L2.4 were significantly lower in cPHPT group than in aPHPT group. Eleven cases （61.1%） and 7 cases （38. 9% ） of aPtlPT were adenoma and hyperplasia, respectively. 197 cases （75. 8% ）, 44 cases （ 16.9% ） and 19 cases （7. 3% ） of cPHPT were adenoma, hyperplasia and carcinoma, respective- ly. The distribution of the pathological types was significantly different between the two groups （P --0. 013 ）. The diame- ters of tumors in aPHPT group and cPHPT group were 2. 24 ± 1.12cm and 2. 82 ± 1.20cm, respectively, P = 0. 050. Conclusion In the present study, compared to classical PHPT patients, the age of diagnosis was older, elevation of pre- surgical serum AKP and

关 键 词：原发性甲状旁腺功能亢进症 无症状型 经典型 临床特点 

分 类 号：R582.1[医药卫生—内分泌]