原发性甲状旁腺功能亢进症(肾石型)33例临床诊治报告

Clinical diagnosis and treatment of primary hyperparathyroidism with urolithiasis(report of 33 cases)

目的探讨原发性甲状旁腺功能亢进症(肾石型)的临床特点,提高对本病的诊治水平。方法回顾性总结自1978至2005年收治33例原发性甲状旁腺功能亢进症(肾石型)的诊治结果。结果本组病例中双侧肾结石29例(87.9%),反复一侧上尿路结石4例(12.1%);手术前后血钙、甲状旁腺激素(PTH)及24h尿液分析的变化差异有显著意义(P<0.01)。术前PTH浓度95%可信限是正常上限的3.8～9.4倍,PTH浓度与血钙浓度正相关(r=0.52)。结论甲状旁腺手术可以明显降低结石复发,甲旁亢的早期诊治有益于减少结石复发和保护肾功能。

Objective To discuss the clinical characteristics of primary hyperparathyroidism with urolithiasis and improve the level of diagnosis and treatment of this illness. Methods Data of 33 cases of primary hyperparathyroidism with urolithiasis from 1978 to 2005 were reviewed and analysed. Results There were 29 （87.9%） cases with bilateral urolithiasis and 4 （12.1%） cases with unilateral relapsed urolithiasis. The statistical discrepancy of serum calcium, PTH and 24-hours urine analysis before and after the operation was significant （P〈0.01）. PTH confidence interval for 95% was 3.8-9.4 times of the normal upper limit. PTH concentration with serum calcium concentration correlation coefficient was R =0.52. Conclusion The parathyroid operation may reduce the calculus recurrence remarkably. Early diagnosis and treatment of primary hyperparathyroidism is helpful to reduce the calculus recurrence and preserve the renal function.