Risk of renal stone events in primary hyperparathyroidism before and after parathyroid surgery: controlled retrospective follow up study
Risk of renal stone events in primary hyperparathyroidism before and after parathyroid surgery: controlled retrospective follow up study
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DOI：
10.1136/bmj.325.7368.807
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发表时间：
2002-10-12
影响因子：
105.7
通讯作者：
Blichert-Toft, M
中科院分区：
文献类型：
--
作者：
Mollerup, CL;Vestergaard, P;Blichert-Toft, M
目的探讨原发性甲状旁腺功能亢进患者手术前后发生肾结石的危险因素。基于设计记录的对照回顾性随访研究。在丹麦设置三级医院。参与者连续674例手术证实的原发性甲状旁腺功能亢进患者。每个患者与从背景人群中随机抽取的三个年龄和性别匹配的对照组进行比较。比较肾结石患者和对照组的住院情况。评估患者肾结石的危险因素。主要观察指标：肾结石发作次数；肾结石住院患者与对照组的比较肾结石危险因素的评估。结果术前结石发生的相对危险度为40(95%可信区间为31 ~ 53)，术后为16（95%可信区间为12 ~ 23）。术前10年风险增加，术后10多年恢复正常。手术后20年无结石生存率为90.4%，对照组为98.7%（风险差异为8.3%，4.8%至11.7%）。术前结石患者术后发生结石事件的风险是对照组的27倍。在手术前，男性比女性有更多的结石发作，年轻患者比老年患者有更多的结石发作。甲状旁腺病理、切除组织的重量、血浆钙水平和骨骼病理（骨折）都不影响肾结石的风险。术后年龄小、术前结石和输尿管狭窄是发生结石的重要危险因素。结论原发性甲状旁腺功能亢进患者发生肾结石的风险增高，手术后降低。术后10年的风险情况正常。术前结石事件增加术后结石的风险。结石形成者和非结石形成者患骨骼并发症的风险相同。
Aim To study the risk of renal stone episodes and risk factors for renal stones in primary hyperparathyroidism before and after surgery.Design Register based, controlled retrospective follow up study.Setting Tertiary hospitals in Denmark.Participants 674 consecutive, patients with surgically verified primary hyperparathyroidism. Each patient was compared with three age- and sex-matched controls randomly drawn from the background population. Hospital admissions for renal stone disease were compared between patients and controls. Risk factors for renal stones among patients were assessed.Main outcome measures Number of renal stone episodes; comparison of hospital admissions for renal stones in patients and controls; assessment of risk factors for renal stones.Results Relative risk of a stone episode was 40 (95% confidence interval 31 to 53) before surgery and 16 (12 to 23) after surgery. Risk was increased 10 years before surgery, and became normal more than 10 years after surgery. Stone-free survival 20 years after surgery was 90.4% in patients and 98.7% in controls (risk difference 8.3%, 4.8% to 11.7%). Patients with preoperative stones had 27 times the risk of postoperative stone incidents than controls. Before surgery, males had more stone episodes than females and younger patients had more stone episodes than older patients. Neither parathyroid pathology, weight of removed tissue, plasma calcium levels, nor skeletal pathology (fractures) influenced the risk of renal stones. After surgery, younger age, preoperative stones and ureteral strictures were significant risk factors for stones.,Conclusions The risk of renal stones is increased in primary hyperparathyroidism and decreases after surgery. The risk profile is normal 10 years after surgery. Preoperative stone events increase the risk of postoperative stones. Stone formers and non-stone formers had the same risk of skeletal complications.