Pallavi Kulkarni , Jacqueline Tucker , Tonya King , David Goldenberg
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引用次数: 1
Abstract
Purpose
Primary hyperparathyroidism (PHPT) is the underlying etiology for 90% of patients with hypercalcemia. PHPT patients have traditionally been characterized as being symptomatic or asymptomatic. However, we submit that even “asymptomatic” patients may still have clinical features, posing the idea of coining asymptomatic disease as a misnomer. This paper presents a systematic review and meta-analysis elucidating the differences between asymptomatic and symptomatic PHPT in the literature.
Methods
A comprehensive literature search was conducted in PubMed, Cochrane, and Web of Science databases for articles published from 2012 to 2022. Inclusion criteria consisted of all studies comparing symptomatic and asymptomatic PHPT patients. Two reviewers independently evaluated the literature using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The level of evidence was determined using the Oxford Center for Level of Evidence-Based Medicine. Data were extracted, and a meta-analysis was performed. I2 index was employed for heterogeneity.
Results
There were 18 studies included, with a total of 4238 patients. The average age of patients included was 56.37, with 25.7% of the cohort being male. Several studies reported clinical features even for the “asymptomatic” group. Patients in the symptomatic group tended to have higher levels of PTH and calcium. The asymptomatic group had greater levels of vitamin D. There was observed heterogeneity between the studies.
Conclusions
More extreme PTH, calcium values, and low vitamin D levels were seen in patients with symptomatic disease. However, asymptomatic patients occasionally exhibited clinical features. Therefore, the terminology of “asymptomatic” disease is likely inappropriate for these patients.
目的原发性甲状旁腺功能亢进(PHPT)是90%高钙血症患者的潜在病因。PHPT患者传统上被定性为有症状或无症状。然而,我们认为,即使是“无症状”患者也可能具有临床特征,将无症状疾病视为用词不当。本文对文献中无症状和有症状PHPT之间的差异进行了系统综述和荟萃分析。方法在PubMed、Cochrane和Web of Science数据库中对2012年至2022年发表的文章进行综合文献检索。纳入标准包括所有比较有症状和无症状PHPT患者的研究。两名评审员使用系统评审和荟萃分析(PRISMA)指南的首选报告项目对文献进行了独立评估。证据水平是使用牛津循证医学水平中心确定的。提取数据,并进行荟萃分析。异质性采用I2指数。结果纳入18项研究,共4238例患者。纳入的患者平均年龄为56.37岁,其中25.7%为男性。几项研究甚至报道了“无症状”组的临床特征。有症状组的患者往往PTH和钙水平较高。无症状组的维生素D水平更高。研究之间存在异质性。结论症状性疾病患者PTH、钙值和维生素D水平较低。然而,无症状患者偶尔表现出临床特征。因此,“无症状”疾病的术语可能不适合这些患者。