原发性甲状旁腺机能亢进症手术治疗后骨量和骨代谢指标的变化

Changes in bone mass and bone metabolic markers in patients with primary hyperparathyroidism after parathytoidectomy

目的 了解甲状旁腺切除术对原发性甲状旁腺机能亢进症病人的骨矿密度及骨代谢指标变化的影响。方法 4 0例病人 ,其中 30例未治疗组 (男 :女 =3:2 7) ;10例已手术治疗组 (男 :女 =3:7) ,手术后时间 1～ 2 4月 (平均 5.3± 7.9月 )。用 DEXA测量腰椎及股骨颈的骨矿密度 ,同时 ,测定血清中的甲状旁腺素 ( PTH) ,骨钙素 ( OC) ,及骨唾液酸蛋白 ( BSP)。结果 在已手术组病人其腰椎及股骨颈骨矿密度再没有明显下降 ,与未治疗组比较无明显变化。在未治疗组 ,血碱性磷酸酶 ( ALP) ,甲状旁腺素 ( PTH) ,骨钙素 ( OC) ,骨唾液酸蛋白 ( BSP)均明显高于已手术组 ( P<0 .0 1)。在未治疗组 ,血 OC与血 PTH具有显著相关性 ( r=0 .58,P<0 .0 1)。结论 在 PHPT血清 ALP、OC及 BSP水平明显升高 ,在手术后显著性降低 ,说明其骨转换率明显下降。血清 BSP作为一新的骨代谢指标 ,可明显反映 PHPT及手术治疗后的骨吸收变化。甲状旁腺切除术可降低 PHPT的骨转换 。

Objective\ To evaluate changes in bone mass and markers of bone metabolism in patients with primary hyperparathyroidism(PHPT)after parathyroidectomy.Methods Of 40 patients with PHPT 30(male:female=3.27) were investigated before operation,and 10(male:female=3:7)at a median of 5.6 months after parathyroidectomy.Measurements of bone mineral density in spine and hip with dual energy X ray absorptiometry were performed in the 2 groups.Concomitantly,changes in serum intact parathyroid hormone(PTH),alkaline phosphatase(ALP),osteocalcin(OC),and bone sialoprotein(BSP)were recorded.Results No significant changes of bone mineral density in the spine and femoral neck were registered before and after operation.Levels of parathyroid hormone,alkaline phosphatase,osteocalcin and bone sialoprotein were elevated before operation,and PTH and OC were intercorrelated before operation.The sereum levels of these paramaters decreased significantly after operation. Conclusion Bone minearl density in the spine and hip is not changed after parathyroidectomy in PHPT.Serum levels of ALP,osteocalcin,and BSP are elevated in PHPT and decrease after operation.Serum BSP as a new bone marker may improve the routine assessment of skeletal disorders in PHPT.Parathyroidectomy may decrease high bone turnover of PHPT.