• 作者：Manuel D&#237 ; ez^a ; ^{mdiez.hupa@salud.madrid.org} ; Tomá ; s Ratia^a ; Mar&#237 ; a José ; Medrano^b ; José ; Mar&#237 ; a Mugü ; erza^a ; M. Rosario San Romá ; n^a ; Carlos Medina^a ; Á ; ngel Rodr&#237 ; guez^a ; Mar&#237 ; a Isabel Sá ; nchez-Seco^a ; Cristina Vera^a ; Raú ; l D&#237 ; az^a ; Pilar Franco^c ; Javier Granell^a
• 关键词：Hiperparatiroidismo primario ; Parathormona intraoperatoria ; Adenoma ; Paratiroides ; Persistencia ; Recurrencia ; Vitamina D
• 刊名：Cirug铆a Espa帽ola
• 出版年：2011
• 期刊代码：pca87_0009739X
• 类别：med
• 出版时间：June-July 2011
• 卷：89
• 期：6
• 页码：386-391
• 文件大小：260 K

Introduction

The relationship between the intra-operative concentration of parathyroid hormone (IOPTH) and the long-term outcome of patients intervened due to primary hyperparathyroidism (PHPT).

Patients and methods

A prospective observational study was performed with 120 patients. Three determinations were made of PTH in blood: baseline, when the diseases gland was located, and 10 minutes after its extirpation. The calcium, PTH and vitamin D (25-OH-D3) levels were measured during follow up.

Results

A decrease in IOPTH >聽50%was observed in 96 (80%) patients, and the post-extirpation value returned to the normal range (Group I), in 18 (15%) a decrease of >聽50%but the final value remained higher than normal (Group II) and in 6 (5%) the decrease was < 50%(Group III). Persistent PHPT was detected during follow up in 6 patients (5%): one in Group I (1%), 3 (16.7%) in II and 2 (33.3%) in group III (P < .001). The risk of persistent PHPT was higher in Group II (odds ratio: 19; 95%CI: 1.85-194) and in Group III (odds ratio: 47; 95%CI: 3.53-639). There were no cases of recurrent PHPT. A normal calcium with an increased PTH was detected in 20 patients of Group I (20.8%), 11 (61.1%) in II and 3 (50%) in III (P < .001). These patients had a lower concentration of post-operative vitamin D (17 ng/ml, range: 24; compared to 28 ng/ml, range: 21) (P = .008) and higher frequency of hypovitaminosis D (70.6%compared to 26.2%) (P>.001).

Conclusion

The risk of persistent PHPT is higher when the IOPTH decreases more than 50%but still remains high.