妊娠合并原发性甲状旁腺功能亢进症六例临床分析  

Diagnosis and treatment of primary hyperparathyroidism in pregnancy:analysis of six cases

作　　者：焦海宁[1] 钟慧萍[1] 刘建民[2] 刘延[1] 陈昕华[1] 杨辰敏[1] 陈曦[3] Jiao Haining;Zhong Huiping;Liu Jianmin;Liu Yan;Chen Xinhua;Yang Chenmin;Chen Xi(Department of Gynecology and Obstetrics,Ruijin Hospital of Shanghai Jiao Tong University,Shanghai 200025,China;Department of Endocrinology,Ruijin Hospital of Shanghai Jiao Tong University,Shanghai 200025,China;Department of Thyroid and Vascular Surgery,Ruijin Hospital of Shanghai Jiao Tong University,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院妇产科,200025 [2]上海交通大学医学院附属瑞金医院内分泌科,200025 [3]上海交通大学医学院附属瑞金医院甲状腺血管外科,200025

出　　处：《中华围产医学杂志》2020年第7期476-483,共8页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨妊娠合并原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)的临床表现、诊断及治疗方案。方法2014年8月至2019年11月上海交通大学医学院附属瑞金医院共收治妊娠合并PHPT患者6例,回顾性分析其临床表现、治疗策略(由产科、内分泌科、新生儿科、普外科、麻醉科、重症医学科等多学科会诊)、母体并发症及母儿转归。结果(1)6例患者中位年龄34(23~38)岁;1例孕前确诊,4例孕中晚期诊断,1例产后确诊。4例临床表现以恶心、呕吐、食欲减退等非特异性症状为主。母体并发症以贫血(5例)多见,其他并发症包括高血钙危象伴肾功能衰竭(1例),多发骨质破坏伴骨质疏松(1例)。6例患者中位血清钙水平为3.08(2.84~4.21)mmol/L,中位血清甲状旁腺激素水平为216.7(93.1~2603.6)ng/L,中位血清25-羟基维生素D水平为29.66(13.50~90.24)nmol/L。所有患者甲状旁腺超声检查均提示存在低回声病灶,4例行甲状旁腺核素显像检查均提示存在异常放射性浓聚区病灶。(2)6例患者均启动产科多学科会诊流程,确定治疗方案,并将会诊意见与患者及家属充分沟通。l例于产后5个月手术治疗;3例孕中期手术治疗,其中1例放弃妊娠行孕中期引产术,其余2例继续妊娠结局良好;2例放弃妊娠引产后手术治疗。术后病理显示,5例为单发甲状旁腺腺瘤,1例为甲状旁腺癌。6例PHPT患者随访至今血钙均正常。(3)1例新生儿生后1个月发生低钙抽搐,予以静脉补钙后治愈,随访至今血钙正常。2例新生儿随访至今血钙正常,但其中1例于4岁时诊断自闭症,现康复治疗中。结论妊娠合并PHPT可导致严重的母儿并发症,产科多学科会诊模式通过多学科的综合诊治可及时诊断、评估病情,通过合理治疗得到较好的妊娠结局。Objective To study the clinical manifestations,diagnosis and treatment of primary hyperparathyroidism(PHPT)in pregnancy.Methods This study involved six pregnant patients with PHPT who were admitted to Ruijin Hospital of Shanghai Jiao Tong University from August 2014 to November 2019.Their clinical manifestations,treatment strategies(multidisciplinary consultation with departments including Obstetrics,Endocrinology,Neonatology,General Surgery,Anesthesiology and Intensive Care Unit),maternal complications and maternal and infant outcomes were described and retrospectively analyzed.Results(1)The median age of the six patients was 34(23-38)years old.PHPT was diagnosed in one case before pregnancy,four in the second or third trimester and one after delivery.The main clinical manifestations of four cases were nausea,vomiting,anorexia and other non-specific symptoms.Anemia was the most common maternal complication(five cases).Other complications included hypercalcemia crisis with renal failure(one case),multiple bone destruction and osteoporosis(one case).The median levels of serum calcium,parathyroid hormone and 25-hydroxyvitamin D were 3.08(2.84-4.21)mmol/L,216.7(93.1-2603.6)ng/L and 29.66(13.50-90.24)nmol/L,respectively.Results of parathyroid ultrasonography showed all patients had hypoechoic focus.Four cases underwent routine parathyroid radionuclide imaging showing abnormal radioactive concentration areas.(2)Obstetricians initiated the multidisciplinary team(MDT)for all patients to determine the treatment plans after communication with the patients and their families.One case received surgical treatment five months after delivery.Three cases received surgical treatment in the second trimester and among them,one terminated the pregnancy in the second trimester and the other two continued and achieved good pregnancy outcomes.Two cases underwent surgical treatment after giving up pregnancy and induced abortion.Postoperative pathology revealed that five cases were isolated parathyroid adenoma and one was parathyroid ca

关 键 词：妊娠并发症 甲状旁腺功能亢进 原发性 多学科团队 妊娠结局 

分 类 号：R714.256[医药卫生—妇产科学]