原发性甲状旁腺功能亢进症患者甲状旁腺切除术前后心脏结构和功能变化

Changes of cardiac structure and function before and after parathyroidectomy in patients with primary hyperparathyroidism

目的探索中国人群原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)患者甲状旁腺切除术前后超声心动图心脏结构及功能的变化。方法2015年至2022年就诊于北京协和医院内分泌科并经手术证实、且临床资料完整的PHPT患者32例,收集其临床数据,包括甲状旁腺切除手术前后实验室指标及超声心动图参数。分析手术前后超声心动图参数变化及主要影响因素。结果32例患者中女性26例,男性6例;年龄(55.3±10.5)岁,病程7.5(3.5,33.0)个月,术后超声心动图复查时间12.0(11.0,43.5)个月,无症状PHPT者占40.6%。术前血钙(2.74±0.20)mmol/L,游离钙(1.39±0.13)mmol/L,全段甲状旁腺激素(intact parathyroid hormone,iPTH)158.1(96.5,208.6)pg/mL,24小时尿钙(7.9±3.0)mmol/L。与术前相比,术后PHPT相关血尿生化指标显著改善,但术后超声心动图参数较术前无显著性差异(P>0.05)。无论是否合并心血管危险因素,PHPT患者的超声心动图参数在行甲状旁腺切除术前后均无显著性差异。校正年龄、体质量指数、血压、心率及病程后进行偏相关分析,术前偏相关分析显示,iPTH与左心室质量指数呈正相关(r=0.574,P=0.002);术后偏相关分析显示,血磷与左心室射血分数(left ventricular ejection fraction,LVEF)呈正相关(r=0.524,P=0.006),iPTH与LVEF呈负相关(r=-0.424,P=0.031)。结论高水平iPTH可能是PHPT患者在甲状旁腺切除手术前左心室肥厚及手术后心脏收缩功能障碍的危险因素;甲状旁腺切除手术后血磷恢复可能有助于改善心室收缩功能。

Objective To explore the effects of parathyroidectomy on cardiac structure and function in the patients with Chinese primary hyperparathyroidism(PHPT).Methods The PHPT patients confirmed by surgery were collected from the Department of Endocrinology of Peking Union Medical College Hospital from 2015 to 2022.Clinical data were collected before and after parathyroidectomy,including laboratory indicators and echocardiographic parameters.The echocardiogram parameters were compared before and after parathyroidectomy and the influential factors for echocardiogram parameters were explored.Results A total of 32 PHPT patients were collected,including 26 females and 6 males.Among them,asymptomatic PHPT accounted for 40.6%.The mean age was(55.3±10.5)years-old,the mean course of disease was 7.5(3.5,33.0)months,the time of repeated echocardiogram after parathyroidectomy was 12.0(11.0,43.5)months.The mean serum calcium was(2.74±0.20)mmol/L,the mean ionic calcium was(1.39±0.13)mmol/L,the median intact parathyroid hormone(iPTH)was 158.1(96.5,208.6)pg/mL,and the mean 24-hour urinary calcium was(7.9±3.0)mmol before parathyroidectomy.Compared with pre-operation,biochemical parameters were improved after parathyroidectomy.Pre-and post-surgery echocardiographic parameters did not differ significantly in overall cases,or in patients with and without cardiovascular risk factors.After adjusting for age,body mass index,blood pressure,heart rate,and course of disease,partial correlation analysis showed that iPTH was positively correlated with left ventricular mass index(r=0.574,P=0.002)in preoperative patients.After parathyroidectomy,the serum phosphorus was positively correlated with left ventricular ejection fraction(LVEF)(r=0.524,P=0.006),while iPTH was negatively correlated with LVEF in postoperative patients(r=-0.424,P=0.031).Conclusions High levels of iPTH might be a risk factor for left ventricular hypertrophy before parathyroidectomy and cardiac systolic dysfunction after parathyroidectomy in PHPT patients.Increase of serum phosphorus level might improve ventricular systolic function after parathyroidectomy.