中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2011年
7期
562-567
,共6页
张凌%姚力%花瞻%卞维静%李文歌
張凌%姚力%花瞻%卞維靜%李文歌
장릉%요력%화첨%변유정%리문가
甲状旁腺功能亢进症,继发性%甲状旁腺切除术%Sagliker综合征
甲狀徬腺功能亢進癥,繼髮性%甲狀徬腺切除術%Sagliker綜閤徵
갑상방선공능항진증,계발성%갑상방선절제술%Sagliker종합정
Hyperparathyroidism,secondary%Parathyroidectomy%Sagliker syndrome
目的 评估甲状旁腺全切除术治疗重症继发性甲状旁腺功能亢进症(SHPT)致Sagliker综合征(SS)的疗效.方法 回顾性分析在我院因SHPT接受甲状旁腺切除术的212例患者中随访3年以上的SS病例.甲状旁腺全切除术疗效判定:术后全段甲状旁腺激素(iPTH)＜150 ng/L为治愈;150～300 ng/L为显效;301～500 ng/L为有效;＞500 ng/L为无效.术后iPTH＞150 ng/L定义为持续性SHPT.术后1周内iPTH＜100 ng/L,以后随访中逐渐上升＞150 ng/L定义为SHPT复发.结果 (1)入选的10例患者中,男4例,女6例,年龄30～54(39.3±10.4)岁.平均透析龄142个月,所有患者都有严重骨关节疼痛,伴进行性面部增大、鸡胸、驼背、髋部骨骼畸形,身高缩短.(2)术前检查:iPTH中位数2000(1800～2863)ng/L;血钙(2.45±0.21)mmol/L,血磷(2.19±0.51)mmol/L,碱性磷酸酶(1189.8±780.0)IU/L.10例患者颈部超声和99Tcm-甲氧基异丁基异腈(MIBI)扫描均证实有增大的甲状旁腺2～4枚.(3)局麻或伞麻下甲状旁腺全切除术.术后结合血钙水平补充钙剂和骨化三醇.(4)术后随访:术后骨痛、肌无力、皮肤瘙痒、失眠、燥热症状明显改善.全部患者术后有低血钙,2例发生一过性声音嘶哑.所有患者术后iPTH显著下降,术后1个月iPTH中位数55.5(10～967)ng/L,较术前显著下降(P＜0.001),其中疗效判定为治愈8例,持续性SHPT 2例(显效1例,无效1例),其中1例于术后第4年死于心力衰竭.长期随访骨骼畸形停止发展,营养不良得到改善,第3年iPTH中位数135(28～390)ng/L(P＜0.001),血钙、血磷和碱性磷酸酶也在达标范围.2例分别于第2年、第3年SHPT复发.结论 甲状旁腺全切除术可以有效治疗SS,改善患者预后,如骨痛消失、骨骼畸形发展停止、改善营养不良.长期随访部分患者iPTH有再升高可能,应该重视监测.
目的 評估甲狀徬腺全切除術治療重癥繼髮性甲狀徬腺功能亢進癥(SHPT)緻Sagliker綜閤徵(SS)的療效.方法 迴顧性分析在我院因SHPT接受甲狀徬腺切除術的212例患者中隨訪3年以上的SS病例.甲狀徬腺全切除術療效判定:術後全段甲狀徬腺激素(iPTH)＜150 ng/L為治愈;150～300 ng/L為顯效;301～500 ng/L為有效;＞500 ng/L為無效.術後iPTH＞150 ng/L定義為持續性SHPT.術後1週內iPTH＜100 ng/L,以後隨訪中逐漸上升＞150 ng/L定義為SHPT複髮.結果 (1)入選的10例患者中,男4例,女6例,年齡30～54(39.3±10.4)歲.平均透析齡142箇月,所有患者都有嚴重骨關節疼痛,伴進行性麵部增大、鷄胸、駝揹、髖部骨骼畸形,身高縮短.(2)術前檢查:iPTH中位數2000(1800～2863)ng/L;血鈣(2.45±0.21)mmol/L,血燐(2.19±0.51)mmol/L,堿性燐痠酶(1189.8±780.0)IU/L.10例患者頸部超聲和99Tcm-甲氧基異丁基異腈(MIBI)掃描均證實有增大的甲狀徬腺2～4枚.(3)跼痳或傘痳下甲狀徬腺全切除術.術後結閤血鈣水平補充鈣劑和骨化三醇.(4)術後隨訪:術後骨痛、肌無力、皮膚瘙癢、失眠、燥熱癥狀明顯改善.全部患者術後有低血鈣,2例髮生一過性聲音嘶啞.所有患者術後iPTH顯著下降,術後1箇月iPTH中位數55.5(10～967)ng/L,較術前顯著下降(P＜0.001),其中療效判定為治愈8例,持續性SHPT 2例(顯效1例,無效1例),其中1例于術後第4年死于心力衰竭.長期隨訪骨骼畸形停止髮展,營養不良得到改善,第3年iPTH中位數135(28～390)ng/L(P＜0.001),血鈣、血燐和堿性燐痠酶也在達標範圍.2例分彆于第2年、第3年SHPT複髮.結論 甲狀徬腺全切除術可以有效治療SS,改善患者預後,如骨痛消失、骨骼畸形髮展停止、改善營養不良.長期隨訪部分患者iPTH有再升高可能,應該重視鑑測.
목적 평고갑상방선전절제술치료중증계발성갑상방선공능항진증(SHPT)치Sagliker종합정(SS)적료효.방법 회고성분석재아원인SHPT접수갑상방선절제술적212례환자중수방3년이상적SS병례.갑상방선전절제술료효판정:술후전단갑상방선격소(iPTH)＜150 ng/L위치유;150～300 ng/L위현효;301～500 ng/L위유효;＞500 ng/L위무효.술후iPTH＞150 ng/L정의위지속성SHPT.술후1주내iPTH＜100 ng/L,이후수방중축점상승＞150 ng/L정의위SHPT복발.결과 (1)입선적10례환자중,남4례,녀6례,년령30～54(39.3±10.4)세.평균투석령142개월,소유환자도유엄중골관절동통,반진행성면부증대、계흉、타배、관부골격기형,신고축단.(2)술전검사:iPTH중위수2000(1800～2863)ng/L;혈개(2.45±0.21)mmol/L,혈린(2.19±0.51)mmol/L,감성린산매(1189.8±780.0)IU/L.10례환자경부초성화99Tcm-갑양기이정기이정(MIBI)소묘균증실유증대적갑상방선2～4매.(3)국마혹산마하갑상방선전절제술.술후결합혈개수평보충개제화골화삼순.(4)술후수방:술후골통、기무력、피부소양、실면、조열증상명현개선.전부환자술후유저혈개,2례발생일과성성음시아.소유환자술후iPTH현저하강,술후1개월iPTH중위수55.5(10～967)ng/L,교술전현저하강(P＜0.001),기중료효판정위치유8례,지속성SHPT 2례(현효1례,무효1례),기중1례우술후제4년사우심력쇠갈.장기수방골격기형정지발전,영양불량득도개선,제3년iPTH중위수135(28～390)ng/L(P＜0.001),혈개、혈린화감성린산매야재체표범위.2례분별우제2년、제3년SHPT복발.결론 갑상방선전절제술가이유효치료SS,개선환자예후,여골통소실、골격기형발전정지、개선영양불량.장기수방부분환자iPTH유재승고가능,응해중시감측.
Objective To evaluate the efficacy of the parathyroidectomy (PTX) in the treatment of severe secondary hyperparathyroidism (SHPT) with Sagliker syndrome (SS). Methods A retrospective review was undertaken among 212 SS patients underwent PTX in our hospital and with more than 3 years' follow up. The definitions of the efficacy were based on the postoperative intact parathyroid hormone level (iPTH). "Cure" showed that the iPTH was ＜ 150 ng/L; "marked effectiveness" was 150-300 ng/L; "effectiveness" was 301-500 ng/L;"ineffectiveness" was ＞500 ng/L. The status was defined as persistent SHPT if iPTH was ＞ 150 ng/L after surgery. The status was considered as SHPT recurrence if iPTH was ＜ 100 ng/L in the first week after surgery, and gradually increased and ＞ 150 ng/L with the follow-up. Results ( 1) Ten patients were involved and the average dialysis time was 142 months [male/female: 4/6; age 30-54 (39. 3 ± 10. 4) years]. All patients had severe bone and joint pain, accompanied with progressive facial increases, chicken breast, kyphosis, hip bone deformities, and body height shortening. (2) Preoperative tests: the median of iPTH 2000(1800-2863) ng/L; serum calcium (2. 45 ±0. 21) mmol/L, phosphorus (2. 19 ±0. 51) mmol/L, alkaline phosphatase ( ALP) (1189. 8 ± 780. 0) IU/L. Two to four enlarged parathyroid glands were confirmed by ultrasound and 99Tcm-MIBI parathyroid scintigraphy. ( 3 ) Surgical procedures: local or general anesthesia for PTX. Supplement with calcium and calcitriol implemented low serum calcium after PTX. (4) Follow-up: symptoms, including bone pain, muscle weakness, skin itching, and insomnia, were significantly improved after surgery. Transient hoarseness occurred in 2 cases. The iPTHs of all patients were decreased significantly after surgery. The median of iPTH was 55.5 ( 10-967) ng/L at 1 month post PTX, and was significantly less than prior to PTX (P＜0. 001). Eight patients were "cure" , 1 "marked effectiveness" ,and 1 "ineffectiveness". Two patients were persistent SHPT, and 1 died of heart failure in the 4th year after PTX. The development of bone deformities was stopped and malnutrition was improved in long-time follow up. The level of iPTH 135(28-390)ng/L(P＜0. 001 ) , serum calcium, phosphorus, and ALP showed normal in the third year. The SHPT recurrence was appeared in the 2nd and 3rd year in 2 out of 8 patients, respectively. Conclusions Total PTX can effectively treat SS by SHPT. It can improve prognosis for patients, such as bone pain disappearing, bone deformities stopping and malnutrition improving, etc. The level of iPTH may rise again in some patients in the future. Therefore, more attentions should be paid to monitoring.
