原发性甲状旁腺功能亢进的诊断及治疗

Diagnosis and treatment of primary hyperparathyroidism

该文概述了原发性甲状旁腺功能亢进(PHPT)的诊断和治疗。PHPT是高钙血症最常见的原因。在欧洲和北美地区,随着血清生化自动分析仪的出现,无症状型PHPT被诊断出来的病例越来越多。目前主要根据患者血钙及甲状旁腺激素(PTH)水平判定其是否有甲状旁腺功能亢进。术前准确定位有助于甲状旁腺病灶完整切除。术前定位常用的是超声检查和^(99m)Tc-MIBI核素显像。术中快速检测PTH水平可评估是否已准确、彻底切除了病变腺体,从而保证手术治疗的成功率。PHPT手术适应证包括:血清钙浓度高于正常上限超过1 mg/dl;骨折;肾结石;任何部位Z评分≤-2. 5;年龄<50岁。对于不能手术、不接受手术及无症状的PHPT患者可选择药物治疗。

This article summarizes the experience in the diagnosis and treatment of primary hyperparathyroidism( PHPT). PHPT is the most common cause of hypercalcemia. In countries where biochemical screening is routine,such as Europe and North America areas,asymptomatic PHPT is diagnosed as a common disease. Blood calcium and PTH should be a screen method for the patients suspected of having PHPT. Preoperation precise localization is helpful for the resection of pathological lesions. Ultrasound and 99mTc-MIBI SPECT have been the most common approaches to pre-operative localization. The use of intraoperative PTH measurements has given assurance about the likelihood of cure after removal of the single or multiply involved parathyroid tissues. PHPT should be recommended to those who meet any one of the criteria for surgery: hypercalcemia consistently > 1 mg/dl above normal;fracture;renal stones;Z-score <-2. 5 at any site;and age < 50 years. In the patients who do not meet any criteria for surgery,a conservative approach with appropriate monitoring is acceptable.