Delayed sampling of intraoperative parathormone may be unnecessary during parathyroidectomy in kidney-transplanted and dialysis patients

Abstract Introduction: Some authors advise in favor of delayed sampling of intraoperative parathormone testing (ioPTH) during parathyroidectomy in dialysis and kidney-transplanted patients. The aim of the present study was to evaluate the intensity and the role of delayed sampling in the interpretation of ioPTH during parathyroidectomy in dialysis patients (2HPT) and successful kidney-transplanted patients (3HPT) compared to those in single parathyroid adenoma patients (1HPT). Methods: This was a retrospective study of ioPTH profiles in patients with 1HPT, 2HPT, and 3HPT operated on in a single institution. Samples were taken at baseline ioPTH (sampling at the beginning of the operation), ioPTH-10 min (10 minutes after excision of the parathyroid glands), and ioPTH-15 min (15 minutes after excision of the parathyroid glands). The values were compared to baseline. Results: Median percentage values of ioPTH compared to baseline (100%) were as follows: 1HPT, ioPTH-10 min = 20% and ioPTH-15 min = 16%; 2HPT, ioPTH-10 min = 14% and ioPTH-15 min = 12%; 3HPT, ioPTH-10 min = 18% and ioPTH-15 min = 15%. Discussion: The reduction was equally effective at 10 minutes in all groups. In successful cases, ioPTH decreases satisfactorily 10 minutes after parathyroid glands excision in dialysis and transplanted patients, despite significant differences in kidney function. The postponed sampling of ioPTH appears to be unnecessary.

摘要 引言：已有学者建议，针对接受甲状旁腺切除术的透析及肾移植患者，术中甲状旁腺激素检测（intraoperative parathormone testing, ioPTH）可采用延迟采样策略。本研究旨在评估延迟采样在透析患者继发性甲状旁腺功能亢进症（2HPT）、成功肾移植后继发性甲状旁腺功能亢进症（3HPT）患者甲状旁腺切除术中ioPTH结果解读中的价值与影响强度，并与单发甲状旁腺腺瘤患者（1HPT）进行对比。
方法：本研究为单中心回顾性研究，纳入接受手术治疗的1HPT、2HPT及3HPT患者，分析其ioPTH检测谱。采样时点包括：基线ioPTH（手术开始时采样）、甲状旁腺切除术后10分钟ioPTH（ioPTH-10 min）、甲状旁腺切除术后15分钟ioPTH（ioPTH-15 min），并将各时点检测值与基线值进行比较。
结果：以基线值（100%）为参照，各时点ioPTH的中位百分比值如下：1HPT组ioPTH-10 min为20%、ioPTH-15 min为16%；2HPT组ioPTH-10 min为14%、ioPTH-15 min为12%；3HPT组ioPTH-10 min为18%、ioPTH-15 min为15%。
讨论：所有组别在术后10分钟时ioPTH的下降效果均相当。在手术成功的病例中，尽管肾功能存在显著差异，但透析及肾移植患者在甲状旁腺切除术后10分钟时，ioPTH即可出现令人满意的下降。由此可见，ioPTH延迟采样似乎并无必要。