Role of calcium malabsorption in the development of secondary hyperparathyroidism after biliopancreatic diversion
Role of calcium malabsorption in the development of secondary hyperparathyroidism after biliopancreatic diversion
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DOI：
10.1007/bf03346429
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发表时间：
2008-10-01
影响因子：
5.4
通讯作者：
Vazquez, C.
中科院分区：
文献类型：
--
作者：
Balsa, J. A.;Botella-Carretero, J. I.;Vazquez, C.
继发性甲状旁腺功能亢进（SH）是减肥手术常见的代谢并发症。大约70%的接受胆胰分流术（BPD）的患者长期存在这种并发症。本研究的目的是评估维生素D缺乏和钙吸收不良对BPD患者SH发生的相对影响。我们回顾了1996年11月至2004年11月（平均随访66个月）在我们研究所接受BPD的121例患者术后随访期间PTH的平均值和相关生化数据（25-羟基维生素D、钙、镁）。平均PTH与平均25-羟基维生素D（r=-0.27，p=0.003）和尿钙（r=-0.19，p=0.047）呈负相关，与年龄呈正相关（r=0.22，p=0.018）。然而，在平均25-羟基维生素D >= 30 ng/ml的患者中发现48.7%的平均PTH较高，在平均25-羟基维生素D在20和30 ng/ml之间的患者中发现80.0%的平均PTH较高。目前未补充钙的5例患者的平均PTH正常，其余患者的平均PTH水平与钙剂量平行逐渐增加，尽管平均25-羟基维生素D水平与钙剂量无关。我们的数据表明，主动和/或被动钙吸收的个体差异决定了约一半25-羟基维生素D水平正常的患者和80% BPD后25-羟基维生素D水平在20和30 ng/ml之间的患者BPD后难治性SH，并随年龄增长而恶化。
Secondary hyperparathyroidism (SH) is a frequent metabolic complication of bariatric surgery. Around 70% of patients who undergo biliopancreatic diversion (BPD) have this complication in the long term. The aim of this study was to evaluate the relative influence of vitamin D deficiency and calcium malabsorption in the development of SH in patients who underwent BPD. We reviewed the mean values of PTH throughout the post-operative follow-up and of related biochemical data (25-hydroxyvitamin D, calcium, magnesium) of 121 patients who underwent BPD at our institute from November 1996 to November 2004 (mean follow-up 66 months). Mean PTH correlated negatively with mean 25-hydroxyvitamin D (r=-0.27, p=0.003) and with urinary calcium (r=-0.19, p=0.047), and positively with age (r=0.22, p=0.018). However, a high mean PTH was found in 48.7% patients with mean 25-hydroxyvitamin D >= 30 ng/ml and in 80.0% patients with mean 25-hydroxyvitamin D between 20 and 30 ng/ml. The mean PTH was normal in 5 patients without calcium supplements at present, and progressively increased in parallel to the calcium dose in the rest of patients, although mean 25-hydroxyvitamin D levels were not related to the calcium dose. Our data suggest that individual differences in active and/or passive calcium absorption determine intractable SH after BPD in around half of the patients who have normal levels of 25-hydroxyvitamin D and in 80% of patients with 25-hydroxyvitamin D levels between 20 and 30 ng/ml after BPD, worsening with age.