Clinical and laboratory characteristics of calcium stone-formers with and without primary hyperparathyroidism
Clinical and laboratory characteristics of calcium stone-formers with and without primary hyperparathyroidism
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DOI：
10.1111/j.1464-410x.2008.08064.x
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发表时间：
2009-03-01
影响因子：
4.5
通讯作者：
Worcester, Elaine M.
中科院分区：
文献类型：
--
作者：
Parks, Joan H.;Coe, Fredric L.;Worcester, Elaine M.
比较原发性甲状旁腺功能亢进（HPT）结石患者与无全身性疾病结石患者的临床表现、实验室特征和治疗结果。（54名女性）患有原发性甲状旁腺功能亢进（HPT）的结石形成者（SF）至2416名（835名女性）无全身性疾病的普通SF和260名正常受试者（NS，106名女性）使用我们的肾结石项目的治疗前和治疗数据。所有患者在治疗前均进行了评估，采集了三份24小时尿液样本，以确定结石风险因素，每份样本均采集了相应的空腹血液样本。回顾了结石率和泌尿系结石相关操作的记录，HPT的高钙血症是适度的，但高钙尿症远比SF显著，因为HPT的钙排泄分数超过SF。HPT的手术治疗并没有完全根除高钙尿症或低磷血症，这表明这些患者有一些额外的矿物质紊乱。血清钙和磷酸盐，和钙的排泄分数，结合成判别函数提供了HPT和SF之间的最佳分离。然而，我们目前的49例患者的诊断（HPT与SF）从未得到解决，尽管多年的观察和成功减少结石复发。HPT中结石的磷酸盐含量略高于SF，但差异不足以引起临床关注。HPT的结石发生率与SF相同，HPT和SF治疗后结石减少量相同，均为10倍。迄今为止，没有研究将HPT与SF和NS进行比较。SF即使有轻微的高钙血症和活跃的高钙尿症也可能有这种可治愈的疾病，治愈后临床医生必须警惕需要药物治疗的残余高钙尿症。有些病人永远不会被完全诊断出来，就像我们的病人一样，仍然是一个谜，尽管对常规的医学治疗有反应。虽然结石中含有少量的磷酸盐，但大多数主要是草酸钙，因此结石分析在临床上不能指导诊断。
To compare the clinical presentation, laboratory features and outcome of treatment in stone formers (SF) with primary hyperparathyroidism (HPT) to those without systemic disease.We compared 105 (54 female) stone-formers (SF) with primary hyperparathyroidism (HPT) to 2416 (835 female) common SF with no systemic disease, and 260 normal subjects (NS, 106 female) using pre-treatment and treatment data from our kidney-stone programme. All were assessed before treatment, with three 24-h urine samples, for stone risk factors, each with a corresponding fasting blood sample. Records were reviewed for stone rates and urological stone-related procedures.The hypercalcaemia of HPT was modest, but hypercalciuria was far more marked than in SF because the fractional calcium excretion of HPT exceeded that of SF. Surgical cure of HPT did not completely eradicate either hypercalciuria or hypophosphataemia, suggesting that these patients have some additional mineral disorder. Serum calcium and phosphate, and fractional excretion of calcium, combined into a discriminant function provided the best separation between HPT and SF. However, we present 49 patients for whom the diagnosis (HPT vs SF) has never been resolved, despite years of observation and successful reduction of stone recurrence. Stones in HPT have slightly more phosphate than SF but the difference is not large enough to be of clinical interest. The stone frequency in HPT is about that for SF, and treatment reduces stones in HPT and SF by about the same amount, 10 times.No study to date has compared HPT with SF and NS, as done here. SF with even slight hypercalcaemia and brisk hypercalciuria probably have this curable disease, and after cure clinicians must be wary of residual hypercalciuria that requires medical treatment. Some patients will never be fully diagnosed and remain, like ours, an enigma, albeit responsive to usual medical treatments. Although stones are modestly enriched with phosphate, most are mainly calcium oxalate, so the stone analysis is not clinically a guide to diagnosis.