140例原发性甲状旁腺功能亢进患者临床资料分析

The analysis of clinical features of 140 cases with primary hyperparathyroidism

目的:探讨不同病理类型的原发性甲状旁腺功能亢进(primary hyperparathyroidism,PHPT)的临床待征。方法:回顾性分析2010年1月至2016年6月首都医科大学附属北京世纪坛医院行手术治疗并经病理学检查确诊的140例PHPT患者的临床资料。结果:术后经病理学检查证实,分为甲状旁腺癌组(parathyroid carcinoma,PC)13例(9.29%),增生组(parathyroid hyperplasia,PH)27例(19.29%),甲状旁腺瘤组(parathyroid adenoma,PA)100例(71.43%)。PC组的病程长,PH组的病程>PA组(P<0.05);PC组年轻患者所占比例较高(P=0.003);PC组病变的直径>PA组,且PA组>PH组(P<0.05);PC组的血钙、甲状旁腺激素(parathyroid hormone,PTH)、碱性磷酸酶(alkaline phosphatase,AKP)、空腹血糖(fasting blood-glucose,FPG)、谷丙转氨酶(alanine aminotransferase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)、谷氨酸转肽酶(glutamete transpeptidase,GGT)、尿素氮(blood urine nitrogen,BUN)、血肌酐(creatine,CRE)最高(P<0.05),且尿钙和尿磷最高(P<0.05);PH组血钙、PTH、AKP、尿钙均<PA组(P<0.05);PC组术后的血钙最低(P<0.001),而PTH水平最高(P<0.001);PC、PH、PA组以骨痛表现的比例为46.15%(6/13)、44.44%(12/27)、49.00%(49/100),3组之间差异无统计学意义(P>0.05);PC组在泌尿系统、消化系统、精神神经系统的表现的比例分别为76.92%(10/13)、76.92%(10/13)、15.38%(2/13),高于PH组和PA组(P<0.05),其中PH组在泌尿系统表现的比例>PA组,PC组病理性骨折、便秘的比例最高30.77%(4/13)、38.46%(5/13)(P<0.05)。结论:PC组的病程较长,发病年龄较年轻;PC组的病变组织最大,PH组病变组织>PA组,术后PC组的血钙最低,而PTH水平最高。PC组的生化和临床表现更为明显。

Objective：To compare the clinical characteristics in primary hyper（-） parathyroid hormone （PHPT） of the different patholog-ic types. Methods：Clinical data of 140 patients with PHPT proved by operation and pathology during January 2010 to June 2016 were retrospectively analyzed. Results：A total of 140 PHPT patients, including 13 （9.29%） cases of parathyroid carcinoma （PC）, 27 （19.29%） cases of parathyroid hyperplasia （PH）, and 100 （71.43%） cases of parathyroid adenoma （PA）. The duration of the PC group was longer than the PH group and the duration of the parathyroid adenoma （PH） group was longer than the PA group （P〈0.05）. The percentage of young patients with PC was higher than in the other two groups （P=0.003）. The diameters of the PC group were larger than those of the other two groups, and those of the PA group were larger than those of the PH groups （P〈0.05）. Blood calcium, parathyroid hor-mone （PTH）, AKP, fasting blood glucose （FBG）, alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, glutamete transpepti-dase （GGT）, blood urine nitrogen （BUN）, creatine （CRE）, urinary calcium, and phosphorus of the PC group were higher than in the oth-er two groups （P〈0.05）. The blood calcium, PTH, alkaline phosphatase （AKP）, urinary calcium of the PH group were lower than those in PA group （P〈0.05）. The proportion of ostalgia was 46.15%（6/13）, 44.44%（12/27）, and 49.00%（49/100）. No statistical difference was observed （P〉0.05）. The postoperative calcium level of PC group was lowest （P〈0.001）, and the highest was of PTH （P〈0.001）. The pro-portions of clinical manifestation of the urinary system, digestive system, and nervous system in the PC group were 76.92%（10/13）, 76.92%（10/13）, and 15.38%（2/13）, respectively, and these values were the highest in the three groups （P〈0.05）. The proportion of the clinical manifestation of the urinary system of the PH group was higher than that of the PA group. The fracture rate （30.77%, 4/13） and constipation rate （38.46%, 5/13） of the PC group were the highest among the three groups （P〈0.05）. Conclusion：The duration of patients with PC was the longest among the three groups. The percentage of young patients with PC was the highest. The abnormal parathyroid glands in the PC group were the heaviest. The PC group exhibited the lowest postoperative calcium level and the highest PTH level. The biochemistry and clinical manifestations of PC were obvious.