原发性甲状旁腺功能亢进伴上尿路结石患者代谢异常的性别差异

Gender differences in patients with primary hyperparathyroidism concurrent with upper urinary tract calculus

目的 分析合并上尿路结石的原发性甲状旁腺功能亢进（PHPT）患者的代谢异常是否存在性别差异. 方法 回顾性分析1997年1月至2013年12月确诊的40例PHPT伴上尿路结石患者资料.男21例,女19例.年龄26～77岁,平均51岁.40例均行甲状旁腺腺瘤切除手术治疗,术前甲状旁腺激素（PTH）水平为（38.42±30.11） pmol/L.术前男性和女性患者PTH水平分别为（29.37±17.64）和（48.47±40.55） pmol/L（P=0.04）.所有患者术后监测PTH水平,手术前后监测血液生化情况.统计分析代谢改变的性别差异. 结果 病理确诊甲状旁腺腺瘤36例,甲状旁腺增生4例.术后患者的高血钙、低血磷获得改善,手术前后男女性比较差异均无统计学意义（P值均＞0.05）.21例患者完成24 h尿液分析,男10例,女11例,男性的尿钙、尿磷显著高于女性[（8.26±2.60）和（6.08±1.59） mmol/24 h,P=0.03;（7.03±1.44）和（5.42± 1.25） mmol/24 h,P=0.01],尿草酸和尿枸橼酸水平比较差异无统计学意义（P值均＞0.05）. 结论 在PHPT伴尿石症的患者中,男性患者的高尿钙症等代谢异常更显著.

Objective To explore the gender differences in patients with primary hyperparathyroidism （PHPT） concurrent with upper urinary tract stone.Methods The clinical data of 40 PHPT concurrent with upper urinary tract stone cases treated from January 1997 to December 2013 were analyzed retrospectively.There were 21 males and 19 females,with an mean age of 51 years （26-77 years）.All patients underwent operation for PHPT,with preoperative parathyroid hormone （PTH） level of （38.42± 30.11）pmol/L.The PTH level in female patients was significantly higher than that in male patients （29.37± 17.64pmol/L versus 48.47±40.55 pmol/L,P=0.04）.Serum biochemical variables were monitored,and 21 cases had 24 h-urinalysis.Results Postoperative pathology confirmed 36 cases of parathyroid adenoma and 4cases of parathyroid hyperplasia.Hypercalcemia and hypophosphatemia were improved with no significant gender difference （both P＞0.05）.But in 21 cases of 24 h-urinalysis,urinary calcium and phosphorus in males were significantly higher than those in females （8.26±2.60 mmol/24 h versus 6.08± 1.59 mmol/24 h,P=0.03; 7.03±1.44 mmol/24 h versus 5.42±1.25 mmol/24 h,P=0.01）.Conclusion In patients with PHPT concurrent with urolithiasis,male patients may be more associated with hypercalciuria.