在甲状腺切除术后预防饥饿骨综合征,治疗原发性和性甲状腺功能障碍症患者
Mara Carsote1, Claudiu Nistor2
1Department of Endocrinology, Carol Davila University of Medicine and Pharmacy & C.I. Parhon National Institute of Endocrinology, Aviatorilor Ave. 34-38, Sector 1, 011863 Bucharest, Romania.
饥饿骨综合征 (HBS) 是副甲状腺切除术 (PTX) 后的一种严重并发症,导致低血症. 早期识别和干预对于初级和性副甲状腺功能障碍患者的HBS管理至关重要.
科学领域:
- 内分泌学 在内分泌学.
- 腎臟病學 (nephrology) 是一種醫學.
- 手术瘤学手术瘤学
背景情况:
- 饥饿骨综合征 (HBS) 是一种严重的并发症,其特点是副甲状腺切除术 (PTX) 后的低血症.
- 在一次性副甲状腺功能障碍症 (PHPT) 或性副甲状腺功能障碍症 (RHPT) 中,长期升高水平后,副甲状腺激素 (PTH) 的快速下降引起这种情况.
- HBS显著损害了潜在的副甲状腺疾病的成功管理.
研究的目的:
- 为PTX后的HBS提供双重视角,检查PHPT和RHPT中手术前和后的结果.
- 综合当前关于HBS的知识,识别风险因素,临床表现和管理策略.
主要方法:
- 基于案例和研究的证据的叙述性审查.
- 在PubMed.中使用关键词"饥饿骨综合征"和"副甲状腺切除术"进行文献搜索.
- 包括从创立到2023年4月出版的文章,重点是原始研究和案例报告.
主要成果:
- 该审查分析了120项原始研究,包括14349例HBS病例.
- 与PHPT患者相比,RHPT患者的HBS风险更高 (15-25%至75-92%),PHPT患者的风险更高 (大约15-25%至75-92%). 在成年人中为20%,在儿童/青少年中为33%.
- 在PHPT中,HBS的关键指标包括手术前升高的PTH,性酸酶和特定瘤特征;在RHPT中,年轻年龄和手术前生化标志物是显著的风险因素.
结论:
- HBS是一种罕见但严重的PTX并发症,具有可预测的元素.
- 对生化标志物,激素概况和临床表现的术前评估有助于识别有风险的患者.
- 快速干预方案,特别是在RHPT中,对于预防症状性低血症,减少住院时间和再接收率至关重要.
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