Mohamed Sherif Ali Ahmed, Ahmed Hamouda, Hassan Magdy, Mohamed Attia Elfadali, Mohamed Hamouda Elkasaby, Mohamed Ehab Eldesoky, Mahmoud M Elsayed, Mohamed Elhawary
{"title":"射频消融治疗继发性甲状旁腺功能亢进的疗效和安全性：一项系统综述和单组荟萃分析。","authors":"Mohamed Sherif Ali Ahmed, Ahmed Hamouda, Hassan Magdy, Mohamed Attia Elfadali, Mohamed Hamouda Elkasaby, Mohamed Ehab Eldesoky, Mahmoud M Elsayed, Mohamed Elhawary","doi":"10.1016/j.ando.2026.102549","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Radiofrequency ablation (RFA) has emerged as a minimally invasive alternative to surgery for secondary hyperparathyroidism (SHPT), but efficacy and safety are still under evaluation. This meta-analysis assesses the effectiveness and complications of ultrasound-guided RFA in SHPT.</p><p><strong>Methods: </strong>We searched PubMed, Scopus, Web of Science, and the Cochrane Library from inception to February 10, 2025, for studies enrolling dialysis patients with SHPT treated by ultrasound-guided RFA. We included observational cohorts and case series (≥10 patients) with ≥6 month's follow-up, reporting changes in intact parathyroid hormone (iPTH), serum calcium or phosphorus; conference Abstracts, case reports, non-human studies, and non-English-language publications were excluded. Random-effects models were used to pool standardized mean differences (SMDs) and complication rates; heterogeneity was assessed using I².</p><p><strong>Results: </strong>Eight retrospective studies (n = 349) were included. RFA was associated with significant reductions in iPTH at 1 day (SMD = -2.64, 95% CI -3.72 to -1.56; p < 0.00001), 6 months (SMD = -2.09, 95% CI -2.54 to -1.64; p < 0.00001), 12 months (SMD = -1.76, 95% CI -2.17 to -1.35; p < 0.00001), and at final follow-up (SMD = -1.47, 95% CI -1.85 to -1.09; p < 0.00001). Serum calcium decreased at 1 day (SMD = -1.26, 95% CI -2.22 to -0.30; p = 0.010), 6 months (SMD = -0.98, 95% CI -1.35 to -0.61; p < 0.00001), 12 months (SMD = -1.15, 95% CI -1.49 to -0.82; p < 0.00001), and final follow-up (SMD = -1.24, 95% CI -2.21 to -0.28; p = 0.010). Serum phosphorus also decreased at 1 day (SMD = -1.25, 95% CI -2.21 to -0.30; p = 0.010), 6 months (SMD = -0.77, 95% CI -1.03 to -0.51; p < 0.00001), 12 months (SMD = -0.73, 95% CI -0.95 to -0.50; p < 0.00001), and final follow-up (SMD = -0.75, 95% CI -1.01 to -0.49; p < 0.00001). Pooled complication rates included hypocalcemia (0.447, 95% CI 0.211-0.682), hoarseness (0.056, 95% CI 0.019-0.093), and recurrent laryngeal nerve injury/paralysis (0.027, 95% CI 0.000-0.066), with substantial heterogeneity in outcomes.</p><p><strong>Conclusion: </strong>RFA is an effective and safe alternative to parathyroidectomy for SHPT, with significant biochemical improvements and low risk of permanent complications. Long-term clinical trials are needed before drawing solid conclusions.</p>","PeriodicalId":93871,"journal":{"name":"Annales d'endocrinologie","volume":" ","pages":"102549"},"PeriodicalIF":2.9000,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy and Safety of Radiofrequency Ablation for Secondary Hyperparathyroidism: A Systematic Review and Single-Arm Meta-Analysis.\",\"authors\":\"Mohamed Sherif Ali Ahmed, Ahmed Hamouda, Hassan Magdy, Mohamed Attia Elfadali, Mohamed Hamouda Elkasaby, Mohamed Ehab Eldesoky, Mahmoud M Elsayed, Mohamed Elhawary\",\"doi\":\"10.1016/j.ando.2026.102549\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Radiofrequency ablation (RFA) has emerged as a minimally invasive alternative to surgery for secondary hyperparathyroidism (SHPT), but efficacy and safety are still under evaluation. This meta-analysis assesses the effectiveness and complications of ultrasound-guided RFA in SHPT.</p><p><strong>Methods: </strong>We searched PubMed, Scopus, Web of Science, and the Cochrane Library from inception to February 10, 2025, for studies enrolling dialysis patients with SHPT treated by ultrasound-guided RFA. We included observational cohorts and case series (≥10 patients) with ≥6 month's follow-up, reporting changes in intact parathyroid hormone (iPTH), serum calcium or phosphorus; conference Abstracts, case reports, non-human studies, and non-English-language publications were excluded. Random-effects models were used to pool standardized mean differences (SMDs) and complication rates; heterogeneity was assessed using I².</p><p><strong>Results: </strong>Eight retrospective studies (n = 349) were included. RFA was associated with significant reductions in iPTH at 1 day (SMD = -2.64, 95% CI -3.72 to -1.56; p < 0.00001), 6 months (SMD = -2.09, 95% CI -2.54 to -1.64; p < 0.00001), 12 months (SMD = -1.76, 95% CI -2.17 to -1.35; p < 0.00001), and at final follow-up (SMD = -1.47, 95% CI -1.85 to -1.09; p < 0.00001). Serum calcium decreased at 1 day (SMD = -1.26, 95% CI -2.22 to -0.30; p = 0.010), 6 months (SMD = -0.98, 95% CI -1.35 to -0.61; p < 0.00001), 12 months (SMD = -1.15, 95% CI -1.49 to -0.82; p < 0.00001), and final follow-up (SMD = -1.24, 95% CI -2.21 to -0.28; p = 0.010). Serum phosphorus also decreased at 1 day (SMD = -1.25, 95% CI -2.21 to -0.30; p = 0.010), 6 months (SMD = -0.77, 95% CI -1.03 to -0.51; p < 0.00001), 12 months (SMD = -0.73, 95% CI -0.95 to -0.50; p < 0.00001), and final follow-up (SMD = -0.75, 95% CI -1.01 to -0.49; p < 0.00001). Pooled complication rates included hypocalcemia (0.447, 95% CI 0.211-0.682), hoarseness (0.056, 95% CI 0.019-0.093), and recurrent laryngeal nerve injury/paralysis (0.027, 95% CI 0.000-0.066), with substantial heterogeneity in outcomes.</p><p><strong>Conclusion: </strong>RFA is an effective and safe alternative to parathyroidectomy for SHPT, with significant biochemical improvements and low risk of permanent complications. Long-term clinical trials are needed before drawing solid conclusions.</p>\",\"PeriodicalId\":93871,\"journal\":{\"name\":\"Annales d'endocrinologie\",\"volume\":\" \",\"pages\":\"102549\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2026-04-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annales d'endocrinologie\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1016/j.ando.2026.102549\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annales d'endocrinologie","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.ando.2026.102549","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景：射频消融（RFA）已成为治疗继发性甲状旁腺功能亢进（SHPT）的一种微创替代方法，但其疗效和安全性仍在评估中。本荟萃分析评估超声引导下射频消融术治疗SHPT的疗效和并发症。方法：我们检索了PubMed， Scopus， Web of Science和Cochrane Library，从成立到2025年2月10日，纳入透析患者接受超声引导RFA治疗的SHPT的研究。我们纳入观察性队列和病例系列（≥10例患者），随访≥6个月，报告完整甲状旁腺激素（iPTH）、血清钙或磷的变化；会议摘要、病例报告、非人类研究和非英语出版物被排除在外。随机效应模型用于合并标准化平均差异（SMDs）和并发症发生率；使用I²评估异质性。结果：纳入8项回顾性研究（n = 349）。RFA与iPTH在第1天（SMD = -2.64, 95% CI -3.72至-1.56,p < 0.00001）、6个月（SMD = -2.09, 95% CI -2.54至-1.64,p < 0.00001）、12个月（SMD = -1.76, 95% CI -2.17至-1.35,p < 0.00001）和最终随访时（SMD = -1.47, 95% CI -1.85至-1.09,p < 0.00001）的显著降低相关。血清钙在第1天（SMD = -1.26, 95% CI为-2.22至-0.30,p = 0.010）、6个月（SMD = -0.98, 95% CI为-1.35至-0.61,p < 0.00001）、12个月（SMD = -1.15, 95% CI为-1.49至-0.82,p < 0.00001）和最后随访（SMD = -1.24, 95% CI为-2.21至-0.28,p = 0.010）下降。血清磷在第1天（SMD = -1.25, 95% CI -2.21至-0.30,p = 0.010）、6个月（SMD = -0.77, 95% CI -1.03至-0.51,p < 0.00001）、12个月（SMD = -0.73, 95% CI -0.95至-0.50,p < 0.00001）和最后随访（SMD = -0.75, 95% CI -1.01至-0.49,p < 0.00001）时也有所下降。合并并发症发生率包括低钙血症（0.447,95% CI 0.211-0.682）、声音嘶哑（0.056,95% CI 0.019-0.093）和喉返神经损伤/麻痹（0.027,95% CI 0.000-0.066），结果存在很大的异质性。结论：RFA治疗SHPT是一种安全有效的替代甲状旁腺切除术的方法，具有显著的生化改善和较低的永久性并发症风险。在得出可靠的结论之前，需要进行长期的临床试验。
Efficacy and Safety of Radiofrequency Ablation for Secondary Hyperparathyroidism: A Systematic Review and Single-Arm Meta-Analysis.
Background: Radiofrequency ablation (RFA) has emerged as a minimally invasive alternative to surgery for secondary hyperparathyroidism (SHPT), but efficacy and safety are still under evaluation. This meta-analysis assesses the effectiveness and complications of ultrasound-guided RFA in SHPT.
Methods: We searched PubMed, Scopus, Web of Science, and the Cochrane Library from inception to February 10, 2025, for studies enrolling dialysis patients with SHPT treated by ultrasound-guided RFA. We included observational cohorts and case series (≥10 patients) with ≥6 month's follow-up, reporting changes in intact parathyroid hormone (iPTH), serum calcium or phosphorus; conference Abstracts, case reports, non-human studies, and non-English-language publications were excluded. Random-effects models were used to pool standardized mean differences (SMDs) and complication rates; heterogeneity was assessed using I².
Results: Eight retrospective studies (n = 349) were included. RFA was associated with significant reductions in iPTH at 1 day (SMD = -2.64, 95% CI -3.72 to -1.56; p < 0.00001), 6 months (SMD = -2.09, 95% CI -2.54 to -1.64; p < 0.00001), 12 months (SMD = -1.76, 95% CI -2.17 to -1.35; p < 0.00001), and at final follow-up (SMD = -1.47, 95% CI -1.85 to -1.09; p < 0.00001). Serum calcium decreased at 1 day (SMD = -1.26, 95% CI -2.22 to -0.30; p = 0.010), 6 months (SMD = -0.98, 95% CI -1.35 to -0.61; p < 0.00001), 12 months (SMD = -1.15, 95% CI -1.49 to -0.82; p < 0.00001), and final follow-up (SMD = -1.24, 95% CI -2.21 to -0.28; p = 0.010). Serum phosphorus also decreased at 1 day (SMD = -1.25, 95% CI -2.21 to -0.30; p = 0.010), 6 months (SMD = -0.77, 95% CI -1.03 to -0.51; p < 0.00001), 12 months (SMD = -0.73, 95% CI -0.95 to -0.50; p < 0.00001), and final follow-up (SMD = -0.75, 95% CI -1.01 to -0.49; p < 0.00001). Pooled complication rates included hypocalcemia (0.447, 95% CI 0.211-0.682), hoarseness (0.056, 95% CI 0.019-0.093), and recurrent laryngeal nerve injury/paralysis (0.027, 95% CI 0.000-0.066), with substantial heterogeneity in outcomes.
Conclusion: RFA is an effective and safe alternative to parathyroidectomy for SHPT, with significant biochemical improvements and low risk of permanent complications. Long-term clinical trials are needed before drawing solid conclusions.
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