| 韩 鹏,姚小宝,刘俊松,许崇文,李宏慧,张少强,赵瑞敏.不同病理类型的原发性甲状旁腺功能亢进临床特征及生化指标的相关性分析[J].,2021,(22):4340-4343 |
| 不同病理类型的原发性甲状旁腺功能亢进临床特征及生化指标的相关性分析 |
| Different Pathological Types of Benign Primary Hyperparathyroidism:Correlation Analysis of Clinical Features and Biochemical Indicators |
| 投稿时间：2020-12-28 修订日期：2021-01-23 |
| DOI：10.13241/j.cnki.pmb.2021.22.029 |
| 中文关键词: 原发性甲状旁腺功能亢进 病理类型 生化指标 |
| 英文关键词: Primary hyperparathyroidism Pathological type Biochemical indicators |
| 基金项目:陕西省自然科学基金项目(2019JQ-957)；中央高校基本科研业务费资助(xjj2018094)；国家自然科学基金青年项目(81833770) |
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| 中文摘要: |
| 摘要 目的：分析不同病理类型的良性原发性甲状旁腺功能亢进（primary hyperparathyroidism，PHPT）患者临床特征和术前术后生化指标变化的不同，探讨其相关性，为该病的诊断与治疗提供思路。方法：收集行手术治疗的良性PHPT患者56 例，回顾性分析其临床资料及术前术后生化指标的变化，并按术后病理结果对其进行分组，比较其临床特征及生化指标的差异。结果：按病理类型将患者分为4组：甲状旁腺腺瘤（PA组）21 例（37.5%），甲状旁腺腺瘤样增生（PAH组）28 例（50.0%），甲状旁腺非典型腺瘤样增生（PAAH组）5例（8.93%），甲状旁腺腺瘤合并甲状旁腺腺瘤样增生（PA+PAH组）2例（3.57%）。PHPT患者中女性明显高发，男女比例为1：5.22，且在PAH组所占比重明显高于PA组（P>0.05）。各组临床表现无明显差异。术前PTH在PAAH组明显高于PAH组，而术前血钙、血磷、25-羟基维生素D3在各组间比较无显著性差异。多处病灶有66.67%发生在PAH组，组间比较有显著性差异（x2=20.160a, P=0.000）。术后病理标本最大直径在PA组明显大于PAH组（P<0.05），而在其余各组间比较无统计学差异（P>0.05）。PTH在术中标本切除后数值迅速下降，在术后第一天略有上升；血钙在术后呈持续下降趋势。PTH及血钙的下降幅度在各组间比较无显著性差异（P>0.05）。结论：良性原发性甲状旁腺功能亢进症中老年女性高发，尤其在PAH组明显高发。各种病理类型临床表现无差异。多处病灶主要集中在PAH组，PA组术后病理标本最大直径最大，PAAH组术前PTH水平最高，应对PAAH组患者加强术后PTH随访。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the clinical features and the biochemical indicators before and after surgery of different pathological types of patients with benign primary hyperparathyroidism （primary hyperparathyroidism，PHPT）, and to explore their correlation and provide ideas for the diagnosis and treatment of the disease. Methods: A total of 56 benign PHPT patients undergoing surgical treatment were collected, and their clinical data and changes in biochemical indicators before and after surgery were retrospectively analyzed. The patients were grouped by postoperative pathological results, and the differences in clinical features and biochemical indicators were compared. Results: The patients were divided into four groups according to pathological types: 21 cases (37.5%) of parathyroid adenoma (PA group), 28 cases (50.0%) of parathyroid adenoma-like hyperplasia (PAH group), 5 cases (8.93%) of atypical parathyroid glands tumor-like hyperplasia (PAAH group), and 2 cases (3.57%) of parathyroid adenoma combined with parathyroid adenoma-like hyperplasia (PA+PAH group). The incidence of female in PHPT patients was significantly higher, male: female ratio was 1:5.22, and the proportion in the PAH group was significantly higher than that in the PA group (P>0.05). There was no significant difference in clinical manifestations in each group; there were not significantly differences in the blood calcium, blood phosphorus, and 25-hydroxyvitamin D3 among the four groups before operation. 66.67% of multiple lesions occurred in the PAH group, and there was significant difference among the four groups (x2=20.160a, P=0.000). The maximum diameter of postoperative pathological specimens in the PA group was significantly larger than that in the PAH group(P<0.05), but there was no statistical difference among the other groups(P>0.05). The value of PTH dropped rapidly after the intraoperative specimen was removed, and rose slightly on the first day after surgery; blood calcium showed a continuous downward trend after surgery. There was no significant difference in the decrease of PTH and blood calcium among the four groups(P>0.05). Conclusion: The incidence of benign primary hyperparathyroidism is high in the middle-aged and elderly women, especially in the PAH group. There is no difference in clinical manifestations of various pathological types. Many lesions were mainly concentrated in the PAH group. The level of PTH before operation in the PAAH group is the highest, so the follow-up of PTH after operation should be strengthened to the PAAH group of patients. |
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