摘要
随着血钙及甲状旁腺素(PTH)等各种实验室检查技术的发展,大量无症状或正常血钙型原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)得以早期诊断。PHPT已成为影响人类健康的第三大常见内分泌系统疾病。目前部分PHPT,尤其是多数正常血钙型PHPT,并非原发,可能是长期钙摄入不足和(或)维生素D缺乏/不足引起的相对低血钙,导致甲状旁腺功能增强,刺激甲状旁腺增生分泌过多的甲状旁腺激素以代偿性调节钙磷平衡。在初期处于可逆阶段时,可经内科药物纠正;如任其发展,长期的低钙刺激将导致甲状旁腺过度增生甚至瘤变,而形成所谓的PHPT,不得不接受手术治疗,临床上对此重视不足。在体检人群中常规进行骨密度及钙镁磷、25-羟维生素D、PTH等骨代谢指标的筛查,有利于骨代谢疾病、泌尿系结石等疾病的防治。同时,应注意识别维生素D缺乏/不足和(或)钙补充不足刺激甲状旁腺功能增强的“甲状旁腺功能亢进症前期”阶段,对它的积极干预是避免发展成“PHPT”的有效手段。
With the development of various laboratory testing techniques such as serum calcium and parathyroid hormone(PTH),a large number of asymptomatic or normocalcemic primary hyperparathyroidism(PHPT)can be diagnosed early.PHPT has become the third most common endocrine disease affecting human health.Currently,most PHPT,especially normocalcemic primary hyperparathyroidism,are not primary diseases and may be related to vitamin D deficiency/insufficiency and/or insufficient calcium supplementation.That is,the relative hypocalcemia caused by long-term vitamin D deficiency/insufficiency and/or insufficient calcium supplementation leads to parathyroid hyperfunction,stimulates parathyroid hyperplasia,and secretes excessive parathyroid hormone to compensate for the regulation of calcium and phosphorus balance.When it is in the initial reversible stage,it can be cured by internal medicine;if it progresses freely,long-term hypocalcemia stimulation will lead to excessive parathyroid hyperplasia and even tumor occurrence with the formation of so-called PHPT and parathyroidectomy has to be performed.Therefore,routine screening of bone mineral density,calcium,magnesium,phosphours,25-hydroxyvitamin D,parathyroid hormone and other bone metabolism indicators in the physical examination of general population is beneficial to the prevention and treatment of bone metabolism diseases,urinary stones and hyperparathyroidism.At the same time,attention should be paid to identifying the stage of prehyperparathyroidism in which vitamin D deficiency/insufficiency and insufficient calcium supplementation will stimulate parathyroid hyperfunction.Active intervention on prehyperparathyroidism is an effective way to avoid the development of primary hyperparathyroidism.
作者
孔令泉
李姝
李浩
田申
伍娟
梁馨予
厉红元
任国胜
吴凯南
Kong Lingquan;Li Shu;Li Hao;Tian Shen;Wu Juan;Liang Xinyu;Li Hongyuan;Ren Guos heng;Wu Kainan(Department of Endocrine and Breast Surgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)
出处
《中华内分泌外科杂志》
CAS
2021年第1期5-9,共5页
Chinese Journal of Endocrine Surgery
基金
国家自然科学基金(81372851)。
