术后甲状旁腺激素对甲状腺全切后永久性甲状旁腺功能减退的预测价值  

Predicting permanent hypoparathyroidism after total thyroidectomy with serum intact parathyroid hormone level on the first postoperative morning

作　　者：侯大卫[1] 徐海娥[2] 袁冰 刘建辉 王子君[1] 鲁一兵[3] 柳明[4] 钱祝银[1] HOU Dawei;XU Haie;YUAN Bing;LIU Jianhui;WANG Zijun;LU Yibing;LIU Ming;QIAN Zhuyin(Department of General Surgery ,the Second Affiliated Hospital of Nanjing Medical University , Nanjing 210011 ,China;The School of Public Healthy Nanjing Medical University , Nanjing 211166 , China;Department of Endocrinology ,the Second Affiliated Hospital of Nan-jing Medical University , Nanjing 210011 , China;Information Central , the Second Affiliated Hospital of Nanjing Medical University , Nanjing 210011 , China)

机构地区：[1]南京医科大学第二附属医院普通外科,江苏南京210011 [2]南京医科大学公共卫生学院,江苏南京211166 [3]南京医科大学第二附属医院内分泌科,江苏南京210011 [4]南京医科大学第二附属医院信息中心,江苏南京210011

出　　处：《中国肿瘤外科杂志》2019年第5期323-326,共4页Chinese Journal of Surgical Oncology

基　　金：江苏省重点研发计划(社会发展)项目(BE2015723)

摘　　要：目的探讨手术次日清晨甲状旁腺激素(PTH)水平对甲状腺全切术后永久性甲状旁腺功能减退(PHOP)的预测价值.方法选取2015年1月至2017年12月南京医科大学第二附属医院收治的行甲状腺全切加中央区淋巴结清扫的134例患者,于术前、术后及随访过程中测量血钙和PTH水平,观察PHOP发生情况,比较PHOP患者术前术后的血钙和PTH水平,使用受试者操作特征(ROC)曲线评估手术次日清晨PTH水平预测甲状腺全切术后PHOP的价值.结果本研究中甲状腺全切加中央区清扫术后PHOP发生率为5.22%(7/134),7例PHOP患者术后6个月的血PTH和血钙水平均低于术前,差异有统计学意义(P<0.05).手术次日清晨PTH水平预测甲状腺全切术后PHOP的ROC曲线下面积为0.936(0.891~0.982),PTH的临界值为8 pg/ml,敏感度100.0%,特异度87.4%,阳性预测值30.4%,阴性预测值100.0%,准确率88.1%.结论术后低PTH水平与甲状腺全切术后PHOP的发生密切相关,手术次日清晨PTH水平是预测甲状腺全切术后PHOP的可靠指标.Objective The aim of present study is to observe the feasibility of predicting permanent hypoparathyroidism(PHOP) after total thyroidectomy with serum intact parathyroid hormone(PTH) level on first postoperative morning. Methods Total 134 cases of patients who underwent total thyroidectomy with concomitant central neck dissection in the Second Affiliated Hospital of Nanjing Medical University from January 2015 to December 2017 were enrolled. The levels of serum total calcium and intact PTH were determined at the following time points: preoperative, postoperative and the programmed follow-up days. The incidence of PHOP was observed six months after the operations were performed. The serum total calcium and intact PTH levels six months after the operations were compared with their preoperative value in patients developing PHOP. Receive operating characteristic curve(ROC Curve) was used to assess the value of serum intact PTH level in the first postoperative morning on predicting PHOP after total thyroidectomy. Results In present study, the total incidence of PHOP after total thyroidectomy with concomitant central neck dissection was 5.22%(7/134). The serum total calcium and PTH levels of all seven patients with PHOP were lower than their preoperative values six months after primary operations with statistical significances(P<0.05) The area under ROC curve was 0.936(0.891~0.982).With the cutoff value of 8 pg/ml, the sensitivity, specificity, positive prediction value, negative prediction value and accurate rate were 100%, 87.4%, 30.4%, 100% and 88.1%% respectively. Conclusions Low level of PTH on the first postoperative morning is closely related with the incidence of PHOP after total thyroidectomy and can be a reliable variable to predict the incidence of PHOP after total thyroidectomy.

关 键 词：甲状腺全切除 甲状旁腺激素 甲状旁腺功能减退 诊断 

分 类 号：R653[医药卫生—外科学]