原发性甲状旁腺功能亢进症合并病理性骨折的诊治分析  

Clinical significance of priamary hyperparathyroidsim patients with pathologic fractures

作　　者：郑志学 柏楠[1] 张自琴[1] 毕敬涛[1] 崔爱民[1] 刘亚奇[1] 蔡轩 谭屾[1] ZHENG Zhi-xue;BAI Nan;ZHANG Zi-qin;BI Jing-tao;CUI Ai-min;LIU Ya-qi;CAI Xuan;TAN Shen(Department of General Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院普外科

出　　处：《中国医刊》2020年第3期293-297,共5页Chinese Journal of Medicine

摘　　要：目的探讨原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)合并病理性骨折的诊断和治疗方法。方法回顾性分析北京积水潭医院2010年1月至2017年12月收治的48例PHPT合并病理性骨折并接受甲状旁腺手术患者的病例资料,对患者的病史、症状体征、实验室检查、影像学资料、围术期及术后随访情况进行总结分析。结果48例PHPT合并病理性骨折患者术前甲状旁腺激素水平均升高,术前大多数患者出现血钙、总Ⅰ型前胶原氨基端延长肽、Ⅰ型胶原羧基端肽β特殊序列、N-端骨钙素、血碱性磷酸酶、尿钙、尿Ca/Cr升高,血磷、25-(OH)D3水平下降。术后1年患者甲状旁腺激素、血钙、总Ⅰ型前胶原氨基端延长肽、Ⅰ型胶原羧基端肽β特殊序列、N-端骨钙素、碱性磷酸酶、尿钙、尿Ca/Cr逐渐下降,血磷、25-(OH)D3水平逐渐上升,与术前比较差异均有显著性(P<0.05)。术后1年复查X线、CT、骨扫描显示所有患者骨折均恢复良好。结论实验室检查和影像学检查为PHPT合并病理性骨折的正确诊治和术后随访提供了重要依据,尽早发现并手术切除原发病灶是治疗PHPT合并病理性骨折的有效方法。Objective In order to improve the diagnosis and therapy,we discuss the pathologic features of priamary hyperparathyroidsim patients with pathologic fracture.Method 48 priamary hyperparathyroidsim patients with pathologic fracture were analyzed in this study,who underwent surgery between January 2010 and December 2017 in Beijing Jishuitan Hospital.Result All of the patients was found with higher parathyroid hormone(PTH)before surgery,and most of them had higher level of serum calcium,tP1NP,βCTX,OC,ALP,urinary Calcium and Ca/Cr,and lower leverl of serum Phosphorus and 25-(OH)D3 before surgery.After sugery they all have signifi cant diff erences compared with preoperative levels.The bone fracture of them had been repaired with X-ray,CT,and Bone scan examination 1 year after surgery.Conclusion The laboratory and videography examinations are important bases for the proper diagnosis,treatment and follow-up of priamary hyperparathyroidsim patients with pathologic fracture.Early diagnosis and surgery of primary tumor is the eff ective treatment of these patients.

关 键 词：甲状旁腺功能亢进症 病理性骨折 甲状旁腺肿瘤 甲状旁腺激素 骨转化标志物 

分 类 号：R582.1[医药卫生—内分泌] R683[医药卫生—内科学]