原发性甲状旁腺功能亢进伴发胰腺炎的临床诊治特点

Pancreatitis in patients with primary hyperparathyroidism

目的回顾性分析原发性甲状旁腺功能亢进（primary hyperparathyroidism，PHPT）伴发胰腺炎病例的临床诊治特点。方法统计2009年1月至2014年5月北京协和医院基本外科手术治疗的PHPT患者病例资料，分析其中胰腺炎的发生情况及临床诊治特点。结果571例PH门患者接受甲状旁腺切除手术治疗。并得到病理学确诊，其中13例（2.3％）同时合并胰腺炎，包括9例急性胰腺炎及4例慢性胰腺炎。PH门合并胰腺炎与术前血清全片段甲状旁腺激素（iPTH）水平〉500pg／ml及出现高钙危象相关（P=O．025及P=0．013），与患者性别、年龄、术前血清总钙水平、是否伴发胆囊结石、泌尿系结石及骨折无关。经过平均34个月的随访，13例均无甲状旁腺功能亢进复发。1例伴有慢性胰腺炎的年轻女性患者术后仍有多次胰腺炎复发，其他患者均无胰腺炎发作。结论PHPT患者中，术前血清iPTH〉500pg／ml及高钙危象是并发胰腺炎的危险因素之一．积极切除甲状旁腺病变，将有助于防止胰腺炎复发。

Objective To investigate the clinical characters of pancreatitis in patients with primary hyperparathyroidism （PHPT）. Methods The clinical data of patients with PHPT undergoing parathyroidectomy from Jan. 2009 to May. 2014 in Peking Union Medical College Hospital were retrospectively analyzed for coexistent pancreatitis. Results 571 patients received parathyroidectomy due to PHPT during this period. Thirteen patients （2.3%）with PHPT were confirmed with coexistent pancreatitis by clinical manifestation and abdominal imaging e- valuation, including acute pancreatitis in 9 patients and chronic pancreatitis in 4 patients. PHPT with pancreatitis was associated with preoperative serum intact parathyroid hormone（iPTH）higher than 500 pg/ml（P=0.025）and oc- currence of hypercalcemic crisis （P=0.013）. The age and sex of patients, preoperative serum calcium, gallstones, urinary calculi and bone fracture were not related with pancreatitis in this group. The average follow-up period for these patients was 34（ranging from 13 to 68）months. All patients were free from hyperparathyroidism recurrence. Only one young lady with chronic pancreatitis suffered from repeated pancreatitis after surgery. Conclusions Serum iPTH higher than 500 pg/ml and occurrence of hypercalcemic crisis were possible risk factor of pancreatitis in pa- tients with PHPT. Parathyroidectomy can help to prevent the recurrence of pancreatitis in these patients.