甲状旁腺功能减退性心肌病的系统综述

目的 甲状旁腺功能减退（甲旁减）性心肌病是一种罕见的心脏疾病，为扩张型心肌病中少数可逆转的一种，常被误诊为不明原因或难治性心力衰竭。本文旨在探寻甲旁减性心肌病的规律性特征。方法 检索Pubmed、SinoMed、万方数据库中符合标准的甲旁减性心肌病病例，采用统计分组法对纳入研究的文献进行分析，依据系统综述和meta分析优先报告条目（PRISMA声明）进行报告。结果 在我们筛查出的41例患者中，女性居多（68.29%），平均年龄为45.5岁，各年龄段均有发病。甲旁减性心肌病最常见的病因为特发性甲旁减（78.05%），颈部手术导致的甲旁减性心肌病次之（17.07%）。患者均以心力衰竭就诊，伴不同程度的低钙血症。51%的患者有神经肌肉兴奋性增加的病史，90%的患者左心室射血分数降低。该病误诊漏诊率较高，仅36%的患者于入院后即明确诊断为甲旁减性心肌病。低血钙的纠正是治疗的关键，90%的患者心脏功能在血钙浓度正常化后恢复至正常。结论 对所有不明原因或难治性心力衰竭患者都应警惕甲旁减性心肌病的可能。

A systematic review of hypoparathyroid cardiomyopathy

Objective Hypoparathyroid cardiomyopathy, a rare heart disease belonging to one of the few reversible forms of dilated cardiomyopathy, is often misdiagnosed as unexplained or refractory heart failure. The characteristics of hypoparathyroid cardiomyopathy were explored. Methods PubMed, SinoMed, and Wanfang database were searched for the cases of hypoparathyroid cardiomyopathy who met the criterion. Statistical grouping method was used to analyze the literature. And the results were reported according to the systematic review and the PRISMA statement. Results A total of 41 patients were screened, women were the majority (68.29%). The average age of patients was 45.5 years. And the disease could be seen in all age groups. The most common cause of parathyroid cardiomyopathy was idiopathic parathyroid hypothyroidism (78.05%), followed by parathyroid cardiomyopathy (17.07%) due to neck surgery. All patients were diagnosed as heart failure with different degrees of hypocalcemia. 51% of patients had a history of increased neuromuscular excitability, and 90% had decreased left ventricular ejection fraction. The rates of misdiagnosis and missed diagnosis were relatively high. Only 36% of patients were accurately diagnosed with parathyroid cardiomyopathy after admission to hospital. The correction of hypocalcemia was the key to treatment, and 90% of patients had their heart function returned to normal after the normalization of serum calcium concentration. Conclusion All patients with unexplained or refractory heart failure should be alert to the possibility of parathyroid cardiomyopathy.