原发性甲状旁腺功能亢进的临床特征分析

doi:10.12114/j.issn.1007-9572.2018.00.112

摘要/Abstract

摘要： 目的　探讨原发性甲状旁腺功能亢进（PHPT）的临床特征，提高临床医生对PHPT的重视。方法　回顾性选取2008—2015年北京医院内分泌科、普通外科病房、骨质疏松症门诊确诊的PHPT患者687例，根据血钙（SCa）水平分组，SCa>2.54 mmol/L者作为1组（348例），SCa为2.03~2.54 mmol/L者作为2组（339例）；根据年龄分组，≤50岁为A组（93例），51~60岁为B组（191例），61~70岁为C组（173例），≥71岁为D组（230例）；根据超声检查结果将患者分为未发现病变组（345例）、腺瘤组（320例）、腺癌组（8例）、其他病变组（14例）。收集一般资料、合并症、甲状旁腺病变切除手术情况，检查甲状旁腺病变情况，检测甲状旁腺激素（PTH）、SCa、血磷（SP）、血肌酐（Scr）、碱性磷酸酶（ALP）、空腹血糖（FPG）、尿钙（UCa）、尿磷（UP）。结果　1组与2组甲状腺病变分布情况比较，差异有统计学意义（P<0.05）；1组肾结石、骨折、甲状旁腺病变切除手术所占比例均高于2组（P<0.05）。B组骨折所占比例低于A组（P<0.05）；C组骨质疏松症所占比例高于A组（P<0.05）；C、D组甲状旁腺病变切除手术所占比例低于B组，腺瘤所占比例均低于A、B组（P<0.05）；D组男性、骨折所占比例均高于B、C组（P<0.05）。腺瘤组年龄、骨质疏松症所占比例、SP、Scr水平均低于未发现病变组，骨折所占比例、SCa均高于未发现病变组（P<0.05）；腺癌组年龄、SP均低于未发现病变组、腺瘤组，肾结石、甲状旁腺病变切除手术所占比例均高于未发现病变组，SCa高于未发现病变组、腺瘤组（P<0.05）；其他病变组骨质疏松症所占比例低于未发现病变组，肾结石所占比例高于未发现病变组、腺瘤组，甲状旁腺病变切除手术所占比例高于未发现病变组，SCa均低于未发现病变组、腺瘤组（P<0.05）。多因素Logistic回归分析显示，年龄、手术、PTH、SCa、SP是PHPT患者甲状旁腺病变的独立危险因素（P<0.05）。结论　PHPT以甲状旁腺瘤最常见，但无病变的PHPT病例亦增多，临床医师需提高对PHPT的认识，常规检测PTH、SCa及颈部超声，尽早明确病因。

关键词: 甲状旁腺功能亢进, 原发性；甲状旁腺肿瘤；疾病特征

Abstract: Objective　To investigate the clinical features of primary hyperparathyroidism（PHPT），improving the premium of physicians paid on PHPT.Methods　We conducted a retrospective analysis of 687 cases of PHPT who received treatment from Department of Endocrinology，General Surgical Wards，and Osteoporosis Clinic，Beijing Hospital from 2008 to 2015.We collected their data concerning demographic data，prevalence of commodities，parathyroid lesion resection，pathological results of parathyroid lesions，serum parathyroid hormone（PTH），serum calcium（SCa），serum phosphorus（SP），serum creatinine（Scr），and alkali phosphatase（ALP），fasting plasma glucose（FPG），urinary calcium（UCa），and urinary phosphate（UP）.We divided them into group 1（348 with SCa >2.54 mmol/L），group 2（339 with SCa of 2.03-2.54 mmol/L） by SCa levels，group A（93 aged ≤50 years），group B（191 aged 51-60 years），group C（173 aged 61-70 years），and group D（230 aged ≥74 years） by age，non-lesion group（345 cases），parathyroidoma group（320 cases），parathyroid carcinoma group（8 cases），and　other lesions group（14 cases） by the results of ultrasound examination.Results　There was significant difference in the distribution of thyroid lesions between group 1 and group 2 （P<0.05），and the proportion of renal calculi，fracture and parathyroid lesions in group 1 was higher than that in group 2（P<0.05）. The proportion of fracture in group B was lower than that in group A（P<0.05）; the proportion of osteoporosis in group C was higher than that in group A（P<0.05）; the proportion of parathyroidectomy in group C and D was lower than that in group B，and the proportion of adenoma was lower than that in group A and B（P<0.05）; the proportion of male and fracture in group D was higher than that in group B and C（P<0.05）. The age，the proportion of osteoporosis，the level of SP and Scr in adenoma group were lower than those in undiscovered group，the proportion of fracture and SCa were higher than those in undiscovered group（P<0.05）; the age and SP in adenoma group were lower than those in undiscovered group and adenoma group，and the proportion of renal calculi and operation were higher than those in undiscovered group，and SCa was higher than that in undiscovered group（P<0.05）. The proportion of osteoporosis in other lesion groups was lower than that in non-lesion group，the proportion of renal calculi was higher than that in non-lesion group and adenoma group，the proportion of parathyroid lesion resection was higher than that in non-lesion group，and SCa was lower than that in non-lesion group and adenoma group（P<0.05）.Multivariate Logistic regression analysis showed that older age，surgical treatment，elevated PTH and SCa and decreased SP levels were independent risk factors for parathyroid lesions in PHPT patients（P<0.05）. Conclusion　Parathyroidoma is the most common cause of PHPT，but asymptomatic cases of PHPT are increasing.Clinicians should increase the awareness of PHPT，routinely perform PTH，SCa，and parathyroid ultrasound examinations on the patients in order to identify the causes of the disease as early as possible.

Key words: Hyperparathyroidism, primary；Parathyroid neoplasms；Disease attributes

王滟,张劲松,缪刚,等. 原发性甲状旁腺功能亢进的临床特征分析[J]. 中国全科医学, 2018, 21(35): 4392-4396. DOI: 10.12114/j.issn.1007-9572.2018.00.112.
WANG Yan,ZHANG Jinsong,MIAO Gang, et al. Clinical Features of Primary Hyperparathyroidism　[J]. Chinese General Practice, 2018, 21(35): 4392-4396. DOI: 10.12114/j.issn.1007-9572.2018.00.112.

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