延迟甲状腺切除术对初级甲状腺功能障碍症成年人未来心血管和脏病干预风险的影响 [原始研究]
Kimberly M Ramonell1, Rachel Liou2, Xinyan Zheng3
1University of Pittsburgh Medical Center, Department of Surgery, Division of Surgical Oncology, Pittsburgh, PA.
Annals of surgery
|August 23, 2024
概括
推迟对原发性甲状腺功能障碍症 (pHPT) 的副甲状腺手术增加了结石再处理和心血管事件的风险. 早期的手术转诊对于更好的患者结果和资源管理至关重要.
科学领域:
- 内分泌学 在内分泌学.
- 腎臟病學 (nephrology) 是一種醫學專業.
- 心血管外科心血管外科
背景情况:
- 未经治疗的原发性偏甲状腺症 (pHPT) 与显著的发病率有关,包括结石和心血管疾病.
- 及时干预对于管理pHPT并发症至关重要.
研究的目的:
- 研究甲状腺外科手术时间对结石再处理和心血管干预风险的影响.
- 评估pHPT和经过副甲状腺切除术 (PTX) 的结石病患者的治疗结果.
主要方法:
- 一项基于人口的队列研究利用了纽约和加利福尼亚州的全州数据 (2000-2020年).
- 包括有结石治疗史的成年患者,被诊断为pHPT,以及随后的PTX.
- 对PTX的结果进行比较,在最初的石头手术后2年内进行,而在最初的石头手术后2年后进行.
主要成果:
- 总共分析了2093名患者,PTX的中位时间为560天.
- 推迟PTX>2年增加了结石再处理的风险59% (HR1.59,P<0.001).
- 延迟PTX还使冠状动脉疾病/干预的风险增加了118% (HR 2.18,P=0.01) 和整体心血管事件的风险增加了52% (HR 1.52,P<0.01).
结论:
- 在有症状的pHPT患者中,延迟侧甲状腺切除术显著增加了需要进一步治疗石头和心血管干预的可能性.
- 早期的外科转诊和多学科护理对于优化pHPT管理中的结果和资源利用至关重要.
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