بررسي ارتباط وزن آدنوم پاراتيروئيد و كلسيم سرم بعد از عمل با يافت ههاي آزمايشگاهي قبل از عمل در بيماران هيپرپاراتيروئيديسم اوليه در بيمارستان دكتر شريعتي

Evaluation of Correlation of Adenoma Weight and Post Operative Calcium with Laboratory Findings in Primary Hyperparathyroidism at Shariati Hospital

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﻫﺪﻑ ﺍﺯ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ، ﺑﺮﺭﺳﻲ ﺍﺭﺗﺒﺎﻁ ﺑﻴﻦ ﺳﻄﺢ ﺳﺮﻣﻲ ﮐﻠﺴﻴﻢ، ﻓﺴﻔﺮ، ﭘﺎﺭﺍﺗﻮﺭﻣﻮﻥ ﻭ ﺁﻟﮑﺎﻟﻴﻦ ﻓﺴﻔﺎﺗﺎﺯ ﻗﺒﻞ ﺍﺯ ﻋﻤﻞ ﺑﺎ ﻭﺯﻥ ﺁﺩﻧﻮﻡ ﻭ ﺳﻄﺢ ﮐﻠﺴﻴﻢ ﺳﺮﻣﻲ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ ﺩﺭ ﺑﻴﻤﺎﺭﺍﻥ ﻫﻴﭙﺮﭘﺎﺭﺍﺗﻴﺮﻭﺋﻴﺪﻳﺴﻢ ﺍﻭﻟﻴﻪ ﺍﺳﺖ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺩﺭ ﺑﺮﺭﺳﻲ ﺁﻳﻨﺪﻩ ﻧﮕﺮ ﺍﺯ ﻣﻬﺮ ﺳﺎﻝ 84 ﻟﻐﺎﻳﺖ ﻣﻬﺮ ﺳﺎﻝ 86، ﻫﺸﺘﺎﺩ ﺑﻴﻤﺎﺭ ﺑﺎ ﺁﺩﻧﻮﻡ ﻭﺍﺣﺪ ﭘﺎﺭﺍﺗﻴﺮﻭﺋﻴﺪ ﻭﺍﺭﺩ ﻣﻄﺎﻟﻌﻪ ﺷﺪﻧﺪ. ﺳﻄﺢ ﮐﻠﺴﻴﻢ ﺳﺮﻡ ﻗﺒﻞ ﺍﺯ ﻋﻤﻞ، ﺳﻄﺢ ﻓﺴﻔﺮ ﺳﺮﻡ، ﺳﻄﺢ ﭘﺎﺭﺍﺗﻮﺭﻣﻮﻥ ﺳﺮﻡ، ﺳﻄﺢ ﺁﻟﮑﺎﻟﻴﻦ ﻓﺴﻔﺎﺗﺎﺯ، ﻭﺯﻥ ﺁﺩﻧﻮﻡ ﻭ ﮐﻠﺴﻴﻢ ﺳﺮﻡ 24 ﺳﺎﻋﺖ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ ﺛﺒﺖ ﺷﺪﻧﺪ. ﺁﻧﺎﻟﻴﺰ ﺁﻣﺎﺭﻱ ﺗﻮﺳﻂ ﺗﺴﺖ ﻫﺎﻱ Student T-test ﻭ Bivariate Correlation ﺍﻧﺠﺎﻡ ﺷﺪ. P<0.05 ﺍﺯ ﻧﻈﺮ ﺁﻣﺎﺭﻱ ﻗﺎﺑﻞ ﻗﺒﻮﻝ ﺗﻠﻘﻲ ﺷﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺍﺭﺗﺒﺎﻁ ﻣﺜﺒﺘﻲ ﺑﻴﻦ ﺳﻄﺢ ﺳـﺮﻣﻲ ﮐﻠﺴـﻴﻢ ﻗﺒﻞ ﺍﺯ ﻋﻤﻞ )R=0.33, P=0.003(، ﺳﻄﺢ ﻫﻮﺭﻣﻮﻥ ﭘﺎﺭﺍﺗﻮﺭﻣﻮﻥ )R=0.61, P<0.001( ﻭ ﺳﻄﺢ ﺳﺮﻣﻲ ﺁﻟﮑﺎﻟﻴﻦ ﻓﺴﻔﺎﺗﺎﺯ )R=0.43, P<0.001( ﺑﺎ ﻭﺯﻥ ﺁﺩﻧﻮﻡ ﻭﺟﻮﺩ ﺩﺍﺷﺖ. ﺍﺭﺗﺒﺎﻁ ﻣﻌﻨﻲ ﺩﺍﺭﻱ ﺑﻴﻦ ﺳﻄـﺢ ﮐﻠﺴﻴـﻢ ﺳـﺮﻡ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ ﺑﺎ ﺳﻄـﺢ ﺁﻟﮑﺎﻟﻴﻦ ﻓﺴﻔﺎﺗﺎﺯ )R=-0.11 P=0.3(، ﺳﻄﺢ ﭘﺎﺭﺍﺗﻮﺭﻣﻮﻥ )R=0.11, P=0.3( ﻭ ﻭﺯﻥ ﺁﺩﻧﻮﻡ )R=-0.17, P=0.1( ﻭﺟـﻮﺩ ﻧﺪﺍﺷـﺖ. ﺍﺭﺗﺒـﺎﻁ ﺿﻌﻴـﻒ ﻣﺜﺒﺘـﻲ ﺑﻴـﻦ ﺳﻄـﺢ ﮐﻠﺴﻴﻢ ﺳﺮﻡ ﺑﻌﺪ ﺍﺯ ﻋﻤـﻞ ﺑﺎ ﮐﻠﺴﻴﻢ ﺳﺮﻡ ﻗﺒﻞ ﺍﺯ ﻋﻤﻞ )R=0.23, P=0.03( ﻭﺟﻮﺩ ﺩﺍﺷﺖ، ﻭﻟﻲ ﺍﺭﺗﺒﺎﻁ ﻣﺜﺒﺖ ﻭ ﻣﻌﻨﻲ ﺩﺍﺭﻱ ﺑﻴﻦ ﻣﻴﺰﺍﻥ ﺍﻓﺖ ﮐﻠﺴﻴﻢ ﺳﺮﻡ ﭘﺲ ﺍﺯ ﺟﺮﺍﺣﻲ ﺑﺎ ﺳﻄﺢ ﮐﻠﺴﻴﻢ ﻗﺒﻞ ﺍﺯ ﻋﻤﻞ )R=0.92, P<0.001(، ﺳﻄﺢ ﭘﺎﺭﺍﺗﻮﺭﻣﻮﻥ )R=0.54, P<0.001(، ﺁﻟﮑﺎﻟﻴﻦ ﻓﺴﻔﺎﺗﺎﺯ ﺳﺮﻡ )R=0.3, P=0.006( ﻭ ﻭﺯﻥ ﺁﺩﻧﻮﻡ )R=0.036, P=0.001( ﻣﺸﺨﺺ ﺷﺪ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﻳﺎﻓﺘﻪ ﻫﺎﻱ ﺁﺯﻣﺎﻳﺸﮕﺎﻫﻲ ﻗﺒﻞ ﺍﺯ ﻋﻤﻞ ﻣﻲ ﺗﻮﺍﻧﻨﺪ ﺩﺭ ﭘﻴﺶ ﺑﻴﻨﻲ ﻭﺯﻥ ﺁﺩﻧﻮﻡ ﭘﺎﺭﺍﺗﻴﺮﻭﺋﻴﺪ ﮐﻤﮏ ﮐﻨﻨﺪﻩ ﺑﺎﺷﻨﺪ. ﮐﻠﺴﻴﻢ، ﭘﺎﺭﺍﺗﻮﺭﻣﻮﻥ ﻭ ﺁﮐﺎﻟﻴﻦ ﻓﺴﻔﺎﺗﺎﺯ ﻗﺒﻞ ﺍﺯ ﻋﻤﻞ ﻣﻌﻴﺎﺭﻫﺎﻱ ﻣﻨﺎﺳﺒﻲ ﺟﻬﺖ ﭘﻴﺶ ﺑﻴﻨﻲ ﺳﻄﺢ ﮐﻠﺴﻴﻢ ﺳﺮﻣﻲ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ ﻧﻤﻲ ﺑﺎﺷﻨﺪ، ﻭﻟﻲ ﺍﻳﻦ ﻣﻌﻴﺎﺭﻫﺎ ﻣﻲ ﺗﻮﺍﻧﻨﺪ ﺩﺭ ﺗﻌﻴﻴﻦ ﻣﻴﺰﺍﻥ ﺍﻓﺖ ﮐﻠﺴﻴﻢ ﺳﺮﻡ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞكمك كننده باشد

Introduction & Objective: To determine the relationship between serum phosphate, serum calcium, and serum parathyroid hormone levels with parathyroid adenoma weight and postoperative serum calcium in primary hyperparathyroidism. Materials & Methods: In a prospective study from 2005 to 2007, eighty patients with single parathyroid adenoma entered the study. Preoperative serum calcium, phosphate, parathyroid hormone, alkaline phosphatase and weight of adenomas were recorded. Postoperative serum calcium was measured 24 hours after adenoma resection. Analysis was performed with student T-test and Bivariate correlation. The level of significance was set at P<0.05. Results: With respect to the adenoma weight, there was a significant correlation with serum calcium and parathyroid hormone (P = 0.003 and, P =0.0001 respectively).There was no correlation between postoperative serum calcium and serum alkaline phosphatase (P=0.3), serum parathyroid hormone (P=0.3) and adenoma weight (P= 0.1). But there was correlation between serum calcium decline after adenoma resection and preoperative serum calcium (r=0.92, P<0.001), parathyroid hormone level (r=0.54, P<0.001), alkaline phosphatase level (r=0.3, P=0.006) and adenoma weight (r=0.036, P=0.001). Conclusions: Adenoma weight has a positive impact on preoperative serum calcium, parathyroid hormone and alkaline phosphatase. Preoperative serum markers and adenoma weight are unreliable for predicting serum calcium level postoperatively, but we can estimate calcium decline postoperatively with preoperative serum calcium, PTH, alkaline phosphatase level and adenoma weight.