治疗性副甲状腺切除术后持续升高的副甲状腺激素:复发性副甲状腺功能障碍症的危险因素
Sophie Dream1,2, Gi Yoon Kim1, Kara Doffek1
1Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
World journal of surgery
|November 17, 2024
概括
在手术治疗原发性副甲状腺症 (PHPT) 后持续升高的副甲状腺激素 (PTH) 是常见的. 虽然大多数患者得到治愈,但由于潜在的长期风险,对复发性PHPT的监测至关重要.
科学领域:
- 内分泌学 在内分泌学.
- 手术瘤学手术瘤学
- 神经外科 神经外科
背景情况:
- 持续升高的副甲状腺激素 (PTH) 水平发生在多达45%的患者中,这些患者因原发性副甲状腺症 (PHPT) 的副甲状腺切除术后.
- 手术后早期这些升高的PTH水平的临床意义尚不清楚.
- 这项研究研究了甲状腺切除术后持续升高的PTH的长期影响.
研究的目的:
- 评估长期临床意义的偏甲状腺激素 (PTH) 水平升高检测到偏甲状腺切除术后早期在患有原发性偏甲状腺症 (PHPT) 的患者.
- 确定持续升高PTH的患者中复发PHPT的发生率.
- 确定与PTH正常化或复发相关的因素.
主要方法:
- 分析了从1999年至2022年间因偶发性PHPT而接受甲状腺切除术的1146名患者的前性收集数据库.
- 术后6个月血清水平正常的患者根据PTH水平 (正常与升高) 被分为组.
- 收集了人口统计数据,与二级甲状腺功能障碍症相关的诊断,以及关于PTH正常化和PHPT复发的随访数据.
主要成果:
- 194名患者 (17%) 在术后6个月的时间内,与正常相比,PTH水平升高.
- 其中,7.2%的人患有复发性PHPT,中位数复发时间为22个月.
- 44.3%的人经历了PTH正常化 (中位数为12个月),并且在组间的二次HPT诊断中没有显著差异.
结论:
- 在PHPT治疗性副甲状腺切除术后,PTH持续升高并不罕见.
- 虽然大多数患者获得了持久的治愈,但PTH升高可能标志着持续或复发的PHPT.
- 在偏甲状腺切除术后PTH升高的患者中,需要对复发进行长期监测.
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