无症状原发性甲状旁腺功能亢进症患者的临床特点

Clinical characteristics of the patients with asymptomatic primary hyperparathyroidism

目的:中国无症状原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)的患病率低于欧美国家且研究较少。本研究旨在探讨无症状PHPT患者的临床特点。方法:回顾性分析150例行手术治疗并经病理检查证实的PHPT患者的临床资料。将患者分为有症状组(n=124)和无症状组(n=26)。结果:无症状PHPT组的腺瘤发生率高于腺癌(P=0.073);无症状PHPT组首诊原因为经常规生化指标检测发现高钙血症的比例高于有症状PHPT组(76.92%vs 25.81%,P<0.001)。与有症状PHPT组比较,无症状PHPT组病程明显较短(中位数12个月vs 24个月,P=0.004),血钙、血清校正钙及甲状旁腺激素明显较低(分别P=0.003、P=0.006及P=0.042),病变直径明显较短(P=0.028),1,25-二羟维生素D_(3)水平明显较高(P<0.001),L_(2~4)和股骨颈的骨密度明显较高(均P<0.001)。结论:无症状的PHPT患者仅占少数,与有症状的PHPT患者比较,无症状PHPT患者的首诊原因主要为高钙血症,其病程短,病变直径小,血钙和甲状旁腺激素水平低,维生素D和腰椎及股骨颈的骨密度较高,病理类型均为良性且腺瘤的比例较高。

Objective:The prevalence of asymptomatic primary hyperparathyroidism(PHPT)in China is lower than that in European and American countries and the study about the characteristics of asymptomatic PHPT was rare in China.This study aims to explore the characteristics of asymptomatic PHPT.Methods:Clinical data of 150 patients with PHPT confirmed by operation and pathological examination were retrospectively analyzed.The patients were assigned into a symptomatic PHPT group(n=124)and an asymptomatic PHPT group(n=26).Results:The proportion of adenomas was higher than that of adenocarcinoma in the asymptomatic PHPT group.The proportion of the first diagnosis due to hypercalcemia found via biochemical examination in the asymptomatic PHPT group was higher than that in the symptomatic PHPT group(76.92%vs 25.81%,P<0.001).The duration was shorter in the asymptomatic PHPT patients than that in the symptomatic PHPT patients(median 12 months vs 24 months,P=0.004).The serum calcium,the albumin-corrected serum calcium,and parathyroid hormone(PTH)were lower in the asymptomatic PHPT patients than those in the symptomatic PHPT(P=0.003,P=0.006,and P=0.042,respectively).The serum 1,25-dihydroxyvitamin D_(3)was higher(P<0.001),the diameter was shorter(P=0.028),and the bone mineral densities(BMD)of L_(2~4)and femoral neck were higher in the asymptomatic PHPT patients than those in the symptomatic PHPT patients(both P<0.001).Conclusion:Only a minority of PHPT patients are asymptomatic.Compared with the symptomatic PHPT patients,the primary cause of diagnosis is hypercalcemia,the duration of diagnosis and the diameter of parathyroid gland are shorter,the levels of serum calcium,and PTH are lower,the proportion of adenomas,vitamin D,and the BMD of L_(2~4)and femoral neck are higher,and the pathological type is benign in the asymptomatic PHPT patients.