继发于甲状旁腺功能亢进的严重骨骼病理损害

Clinical analysis of severe secondary bone diseases caused by primary hyperparathyroidism

目的探讨继发于甲状旁腺亢进症(PHPT)的严重骨骼病理损害的临床特点。方法回顾2015年1月至2018年1月北京积水潭医院以复杂骨病损为首诊的21例PHPT患者的临床资料,分析其临床特征。结果 21例PHPT患者,男13例,女8例。年龄15～57岁。依据首诊骨病理损伤表现将其分类:骨肿瘤11例(骨肿瘤首诊),骨折14例(单纯骨折创伤骨科首诊),骨骼畸形4例(矫形骨科首诊)。其中19例患者出现严重骨质疏松。其他表现为骨痛、乏力等。生化指标统计提示:血Ca、甲状旁腺素(PTH)、碱性磷酸酶(ALP)均明显高于正常范围,血P低于正常范围。其中11例患者转入普通外科行甲状旁腺切除,11例骨肿瘤患者均于行病理活检,排除恶性病变,行保守治疗。结论对多发骨破坏、骨骼畸形等严重骨病理损害患者,应警惕甲状旁腺功能亢进可能,密切监测血Ca、PTH、ALP、颈部超声或CT等相关检查,一旦确诊,及时治疗,阻止进一步骨质损害。

Objective To investigate the severe secondary bone diseases caused by primary hyperparathyroidism(PHPT).Methods Twenty-one cases were reviewed in Beijing Jishuitan Hospital from January2015to January2018.These patients represented with complicated bone lesion first and were diagnosed with hyperparathyroidism later.Results The initial manifestation of the 21 patients with hyperparathyroidism,13males and8females,with age ranging from12to57,included bone tumor(11cases),fracture(14cases)and bone deformity(4cases).Among them,19patients developed severe osteoporosis.Other symptoms include bone pain and fatigue.Laboratory examinations showed significantly elevated serum calcium,serum parathyroid hormone and serum alkaline phosphatase.Lower-than-normal serum phosphorus was also noticed among these patients.General surgery and total thyroidectomy was performed on11patients.Patients with bone tumor(11cases)were treated non-surgically after bone biopsy to rule out malignancy.Conclusion Patient represent with complicated bone lesion,including multi-focal bone lesion or bone deformity should be suspect with hyperparathyroidism.Serum calcium,parathyroid hormone and alkaline phosphatase should be performed and closely monitored.Neck ultrasound or computed tomography should be performed once hyperparathyroidism is suspected.An early diagnosis and prompt intervention prevents further bone loss and contribute to more favorable prognosis.