原发性甲状旁腺功能亢进成功手术后血清甲状旁腺激素再升高的原因分析  

The re-elevation of parathyroid hormone level after successful operation for primary hyperparathyroidism

作　　者：杨瑞瑶 刘安阳[1] 罗斌[1] Yang Ruiyao;Liu Anyang;Luo Bin(Department of General Surgery,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院普通外科,清华大学临床医学院,北京102218

出　　处：《中华普通外科杂志》2023年第10期754-759,共6页Chinese Journal of General Surgery

摘　　要：目的探讨原发性甲状旁腺功能亢进症(primary hyperparathyroidism, pHPT)患者成功手术后血清甲状旁腺素(parathyroid hormone, PTH)再次升高的概率、影响因素及处理策略。方法回顾性分析2016年1月至2021年3月北京清华长庚医院收治的40例pHPT患者的临床资料。结果 40例pHPT患者中术后有21例(53%)出现血清PTH再升高, 但血钙值均正常, 并且颈部超声检查未发现有新出现的甲状旁腺病变。单因素分析发现:术后血清PTH再升高组与正常组在肿瘤直径、术前血清PTH值、术前血钙值、术前碱性磷酸酶值方面的差异均有统计学意义(t=-2.042, P=0.045;t=-2.600, P=0.013;t=-2.223, P=0.043;t=-2.162, P=0.037)。回归分析发现术前血清PTH值>236 ng/L是术后血清PTH再升高的独立危险因素(OR= 5.180, 95%CI: 1.032~25.995)。pHPT患者的25-羟基维生素D缺乏较普遍, 占88%。患者术前血清PTH水平与25-羟基维生素D水平呈负相关。对其中4例术后血清PTH再升高的患者补充维生素D后, 升高的血清PTH可以回落至正常水平。结论 pHPT患者成功切除甲状旁腺瘤后血清PTH再升高的概率为53%, 多数在术后短期内发生(8周内), 但这并非疾病复发。较高的术前血清PTH值是预测术后血清PTH再升高的独立危险因素。pHPT患者中25-羟基维生素D缺乏较普遍, 纠正维生素D可使患者术后血清PTH恢复正常。Objective To explore the probability,influencing factors,and management strategies of the re-increase of parathyroid hormone(PTH)in patients with primary hyperparathyroidism(pHPT)after successful surgery.Methods A retrospective analysis of the clinical data of 40 pHPT patients treated at Beijing Tsinghua Chang Gung Hospital from Jan 2016 to Mar 2021 was conducted.Results Of the 40 pHPT patients,21(53%)experienced a re-increase of PTH after surgery,but their serum calcium levels were normal and no new parathyroid lesions were found on neck ultrasonography.Univariate analysis showed that there were significant differences in tumor diameter,preoperative PTH level,preoperative serum calcium level,and preoperative alkaline phosphatase level between the postoperative PTH re-increase group and the normal group(t=-2.042,P=0.045;t=-2.600,P=0.013;t=-2.223,P=0.043;t=-2.162,P=0.037).Regression analysis showed that preoperative PTH level>236 ng/L was an independent risk factor for postoperative PTH re-increase(OR=5.180,95%CI:1.032-25.995).Vitamin D deficiency was common among pHPT patients(88%),and there was a negative correlation between preoperative PTH and 25-hydroxy vitamin D levels.After vitamin D supplementation,the PTH levels of four patients with postoperative PTH re-increase returned to normal.Conclusions The probability of PTH re-increase in pHPT patients after successful parathyroidectomy was 53%,and most cases occurred in the short term after surgery(within 8 weeks),but it did not indicate disease recurrence.A higher preoperative PTH level was an independent risk factor for postoperative PTH re-increase.Vitamin D deficiency was more common among pHPT patients,and correction of vitamin D deficiency can help restore normal PTH levels after surgery.

关 键 词：甲状旁腺功能亢进症 原发性 甲状旁腺素 维生素D 

分 类 号：R653[医药卫生—外科学]