正常血钙型原发性甲状旁腺功能亢进症的临床特征及影响因素研究  

Clinical Characteristics and Risk Factors of Normocalcemic Primary Hyperparathyroidism

作　　者：黄泽宇 苏磊[2] 桑剑锋[2] 赵茹 韩晨 王茜[1] 顾天伟[1] 毕艳[1] 朱大龙[1] 沈山梅[1] HUANG Zeyu;SU Lei;SANG Jianfeng;ZHAO Ru;HAN Chen;WANG Qian;GU Tianwei;BI Yan;ZHU Dalong;SHEN Shanmei(Department of Endocrinology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Thyroid Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院内分泌科,江苏省南京市210008 [2]南京大学医学院附属鼓楼医院甲状腺外科,江苏省南京市210008

出　　处：《中国全科医学》2023年第11期1369-1374,共6页Chinese General Practice

基　　金：国家自然科学基金重点项目(82030026)。

摘　　要：背景正常血钙型原发性甲状旁腺功能亢进症(NCPHPT)作为原发性甲状旁腺功能亢进症(PHPT)的一种新类型近年来逐渐受到重视,该类型在临床中易被误诊,其相关影响因素也有待探究。目的分析NCPHPT的临床特征,探讨发生NCPHPT的影响因素。方法回顾性选取2016年1月至2021年12月在南京大学医学院附属鼓楼医院确诊为PHPT的患者153例,根据校正血钙水平分为正常血钙组和高钙组;并以同期行健康体检且甲状旁腺功能正常者作为健康对照组。比较生化指标、糖代谢、骨代谢、影像学及病理学在不同组间的差异,采用多因素Logistic回归分析探究发生NCPHPT的影响因素。结果153例PHPT患者中正常血钙组36例、高钙组117例,健康对照组50例。在生化指标方面,与健康对照组相比,正常血钙组患者的碱性磷酸酶(AKP)、尿酸(UA)、甲状旁腺激素(PTH)水平升高,血磷降低(P<0.05);与高钙组相比,正常血钙组患者血钙、AKP、血肌酐(Scr)、UA、PTH降低,血磷及估算肾小球滤过率(eGFR)升高(P<0.05)。在糖代谢方面,与健康对照组相比,正常血钙组的糖化血红蛋白(HbA_(1c))、胰岛素抵抗指数(HOMA-IR)升高(P<0.05),高钙组空腹血糖(FPG)、空腹胰岛素(FIns)、HOMA-IR升高(P<0.05)。在骨代谢指标及骨密度方面,正常血钙组的Ⅰ型前胶原氨基端延长肽(P1NP)、Ⅰ型前胶原C端肽β降解产物(β-CTX)、骨钙素(OC)、降钙素(CT)较健康对照组高,第1腰椎~第4腰椎(L_(1~4))及股骨颈密度较健康对照组降低(P<0.05);与高钙组相比,正常血钙组的P1NP、β-CTX、OC、CT均降低,股骨颈密度升高(P<0.05)。正常血钙组及高钙组甲状旁腺占位均好发于下极。正常血钙组和高钙组病变的直径、位置和异位情况比较,差异无统计学意义(P>0.05);正常血钙组多腺体病变率高于高钙组(P<0.05);两组病理类型比较,差异无统计学意义(χ^(2)=8.556,P>0.05)。多因素Logistic回归分析显示合Background Normocalcemic primary hyperparathyroidism(NCPHPT),as a new phenotype of primary hyperparathyroidism(PHPT),has gained increasing attention.NCPHPT is easily misdiagnosed in clinical practice,and its risk factors need to be evaluated further.Objective To investigate the clinical features of NCPHPT and to explore its risk factors.Methods Patients diagnosed with PHPT(n=153)were retrospectively selected from Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from January 2016 to December 2021,and divided into an experimental group(NCPHPT group)and a hypercalcemia PHPT group according to the corrected total serum calcium level.Meanwhile,individuals undergoing physical examination with normal parathyroid function were selected as the control group.The differences in clinical characteristics,glucose and bone metabolism,imaging and pathology results among the groups were compared.Multivariate Logistic regression analysis was used to analyze the risk factors of NCPHPT.Results The number of cases in NCPHPT,hypercalcemia PHPT and control groups was 36,117 and 50,respectively.For biochemical indices,compared with healthy control group,the levels of alkaline phosphatase(AKP),uric acid(UA),and parathyroid hormone(PTH)were much higher in NCPHPT group,while serum phosphorus was much lower(P<0.05).Compared with hypercalcemia PHPT group,the NCPHPT group had notably lower levels of serum calcium,AKP,serum creatinine(Scr),UA and PTH,and significantly higher serum phosphorus level and estimated glomerular filtration rate(eGFR)(P<0.05).In terms of glucose metabolism,the glycated hemoglobin(HbA_(1c)),and insulin resistance index(HOMA-IR)in NCPHPT group were much higher than those in the control group(P<0.05),the FPG,fasting insulin(FIns)and HOMA-IR in hypercalcemia PHPT were much higher than that in control group(P<0.05).In terms of bone metabolism indices and bone mineral density,the NCPHPT group had much higher levels of P1NP,serumβ-crosslaps(β-CTX),osteocalcin(OC)and calcitonin(CT),an

关 键 词：甲状旁腺功能亢进 原发性 正常血钙型原发性甲状旁腺功能亢进症 骨代谢 葡萄糖代谢障碍 影响因素分析 疾病特征 

分 类 号：R582.1[医药卫生—内分泌]