关键词: 继发性甲状旁腺功能亢进症, 甲状旁腺切除术, 骨转换标志物, 骨密度, 生存质量

Abstract: Objective To explore a better surgical treatment for secondary hyperparathyroidism(SHPT), so as to provide evidence-based basis for clinical treatment, and further improve the quality of life and prognosis of patients. Methods The clinical data of 75 patients with SHPT admitted to the Department of Thyroid and Breast Surgery, the 960th Hospital of PLA Joint Logistics Support Force from December 2021 to February 2023 were retrospectively analyzed. According to the condition, the patients were divided into total parathyroidectomy(TPTX)group(n=35)and total parathyroidectomy with autotransplantation(tPTX+AT)group(n=40). The changes of parathyroid hormone, serum calcium and serum phosphorus were monitored before operation and 1 day, 1 month, 3 months, 6 months and 1 year after operation. The time and amount of intravenous calcium supplement(calcium gluconate)during hospitalization, perioperative complications and recurrence were evaluated and analyzed in the two groups. Meanwhile, before and after operation(6 months, 1 year)bone formation markers, i.e. N-terminal propeptide of type Ⅰ collagen, bone resorption markers, i.e. β cross-linked C-telopeptide of type I collagen, spinal bone mineral density and bone mineral density of the left femoral neck T value scores were compared. The MOS 36-item short-form health survey(SF-36)was used to evaluate the quality of life of patients before and after operation(6 months,1 year). Results There was no significant difference in baseline data between the two groups(P>0.05). There was no statistically significant difference in the number of parathyroid glands removed and the situation of combined thyroid surgery between the two groups(P>0.05). There was no statistically significant difference in calcium supplementation time and amount during hospitalization between the two groups(P>0.05). There was no statistically significant difference in the incidence of recurrent hyperparathyroidism(RHPT)and the incidence of hypocalcemia 1 year after surgery between the two groups(P>0.05). There was a statistically significant difference in the incidence of permanent hypoparathyroidism between the two groups(P<0.01). The levels of blood calcium, phosphorus, and parathyroid hormone parathyroid hormone in both groups on the 1 day, 1 month, 3 months, 6 months, and 1 year after surgery were significantly lower than those before surgery(P<0.05). The blood calcium level was the lowest 1 month after surgery, gradually increased 3 months after surgery, and tended to be stable and basically close to the normal value 1 year after surgery. In the TPTX group, parathyroid hormone dropped sharply after surgery and showed no significant change from 1 day to 1 year after surgery. In the tPTX+AT group, parathyroid hormone also dropped sharply after surgery. There was no significant change from 1 day to 1 month after surgery. Compared to 1 month after surgery, the increase in parathyroid hormone 3 months after surgery was statistically significant(P<0.05). Compared to 1 day and 1 month after surgery the increase in parathyroid hormone 6 months and 1 year after surgery was statistically significant(P<0.05). The levels of N-terminal propeptide of type Ⅰ collagen and β cross-linked C-telopeptide of type I collagen in both groups at 6 months and 1 year after surgery were significantly lower than those before surgery(P<0.05). N-terminal propeptide of type Ⅰ collagen continued to decline at 1 year after surgery compared to 6 months after surgery(P<0.05). There was no significant difference in the degree of decline of β cross-linked C-telopeptide of type I collagen between 1 year after surgery and 6 months after surgery(P>0.05). The T-scores of spinal and left femoral neck bone mineral density in both groups at 6 months and 1 year after surgery were significantly higher than those before surgery(P<0.05). The spinal bone mineral density gradually approached the normal value at 6 months after surgery. There was no significant change between 1 year and 6 months after surgery(P>0.05). The left femoral neck bone mineral density continued to increase at 1 year after surgery compared to 6 months after surgery(P<0.05). There was no statistically significant difference in N-terminal propeptide of type Ⅰ collagen, β cross-linked C-telopeptide of type I collagen, spinal bone mineral density, and left femoral neck bone mineral density between the two groups(P>0.05). SF-36 scale analysis revealed the scores of physical function, role physical, body pain, general health, vitality, social function, role emotional and mental health in the TPTX group and tPTX+AT group after surgery(6 months, 1 year)were significantly higher than those before surgery(P<0.05), but there was no significant improvement at 1 year after operation compared with 6 months after operation(P>0.05), and there was no significant difference between the two groups(P>0.05). Conclusion TPTX and tPTX+AT have good effects on controlling the levels of serum calcium, phosphorus and other biochemical indicators, improving the quality of life, and improving bone metabolism disorders in patients with SHPT. The incidence of permanent hypoparathyroidism in the tPTX+AT group is lower than that in the TPTX group. tPTX+AT may be a better choice for the treatment of secondary hyperparathyroidism.

Key words: Secondary hyperparathyroidism, Parathyroidectomy, Bone turnover markers, Bone mineral density, Quality of life