尿毒症继发性甲旁亢患者甲状旁腺全切联合自体移植术后早期发生低钙血症的危险因素  

Risk factors for early hypocalcemia after total parathyroidectomy with autotransplantation in patients with uremic secondary hyperparathyroidism

作　　者：姜超云[1,2] 李洋[1,3] 王素霞[4] 王尊松[1] 

机构地区：[1]山东大学附属千佛山医院肾内科,济南250014 [2]山东大学医学部,济南250012 [3]潍坊医学院临床医学系,山东潍坊261053 [4]济南军区总医院肾内科,济南250031

出　　处：《第三军医大学学报》2017年第5期472-476,共5页Journal of Third Military Medical University

基　　金：山东省自然科学基金科研课题(ZR2010HL012);山东省科技发展计划(2012YD18079)~~

摘　　要：目的探讨尿毒症继发性甲旁亢患者在甲状旁腺切除术后早期发生低钙血症的危险因素。方法回顾性分析2013年7月至2016年8月116例接受甲状旁腺切除术的尿毒症继发性甲旁亢患者资料,根据术后24 h内血钙浓度分为2组:正常血钙组(术后钙浓度>2 mmol/L)33例,低钙组(术后钙浓度≤2 mmol/L)83例。应用逐步Logistic回归,分析患者的年龄、透析时间、术前血钙、术前血红蛋白、术前ALP和术前PTH等指标。结果患者术前低血钙(95%CI 0.11~0.37,P=0.001)、高浓度碱性磷酸酶(95%CI 0.71~0.93,P<0.001)和甲状旁腺激素(95%CI 0.58~0.85,P=0.003)为术后早期发生低钙血症的独立危险因素。结论术前低血钙、高浓度碱性磷酸酶和甲状旁腺激素是术后早期低钙血症的独立危险因素。Objective To investigate the risk factors for early hypocalcemia after parathyroidectomy in the patients with uremic secondary hyperparathyroidism. Methods One hundred and sixteen uremic patients with secondary hyperparathyroidism and underwent total parathyroidectomy with autotransplantation in the Qianfoshan Hospital and General Hospital of Jinan Military Command from July 2013 to August 2016 were enrolled in the study. According to the post-operative serum calcium （Ca） levels within 24 h, the patients were divided into the normocalcemia group （ n = 33, 〉 2 mmol/L） and the hypocalcemia group （ n = 83, ≤2 mmol/L）. A stepwise logistic regression analysis was used to analyze the age, vintage of dialysis, pre- operative Ca, pre-operative hemoglobin, pre-operative alkaline phosphatase and pre-operative parathyroid hormone to determine the risk factors for early hypocalcemia. Results Logistic regression analysis indicated that pre-operative hypocalcemia （95% CI： O. 11 - 0.37, P = 0. 001 ）, high levels of alkaline phosphatase （95% CI： 0.71 - 0.93, P 〈 0. 001 ） and parathyroid hormone （95% CI： 0.58 - 0.85, P = 0. 003 ） were independent risk factors of early hypocalcemia after parathyroidectomy. Conclusion Pre-operative hypocalcemia, and high levels of alkaline phosphatase and parathyroid hormone are independent risk factors for early hypocalcemia after parathyroidectomy.

关 键 词：尿毒症 继发性甲状旁腺功能亢进 甲状旁腺全切联合自体移植术 低血钙 

分 类 号：R582.1[医药卫生—内分泌] R591.1[医药卫生—内科学]