原发性甲状旁腺功能亢进术后暂时性甲状旁腺激素分泌抑制的危险因素分析  

Analyses of risk factors for temporarily inhibited parathyroid hormone secretion of postoperative primary hyperparathyroidism

作　　者：刘星 赵腾 王嘉程 申虹 王倩[1] 辛云慧 魏伯俊[1] Liu Xing;Zhao Teng;Wang Jiacheng;Shen Hong;Wang Qian;Xin Yunhui;Wei Bojun(Department of Thyroid and Neck Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院甲状腺颈部外科,100020

出　　处：《中华耳鼻咽喉头颈外科杂志》2020年第5期497-500,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)患者手术后出现暂时性甲状旁腺激素(parathyroid hormone,PTH)分泌抑制的相关危险因素。方法回顾性分析2017年10月至2019年3月首都医科大学附属北京朝阳医院甲状腺颈部外科收治的72例PHPT患者的临床资料,其中男性22例,女性50例,年龄13~83岁。根据术后第1日PTH水平将患者分为完全抑制组(PTH=0 pg/ml)24例、不完全抑制组(0<PTH<12.4 pg/ml)23例及无抑制组(PTH≥12.4 pg/ml)25例,比较3组间术前、术后生化及内分泌指标,包括术前血清钙、血清磷、PTH、25-羟基维生素D、碱性磷酸酶,病灶切除10 min后PTH,术后第1日血清钙,术后第3日PTH,以寻找导致暂时性PTH分泌抑制的危险因素,3组间统计比较应用Kruskal-Wallis多组秩和检验,两两比较行Nemenyi检验,并用ROC曲线分析各危险因素对术后暂时性PTH分泌抑制的预测价值。结果完全抑制组术前PTH、术前血钙及术后第1日血钙均高于无抑制组,差异有统计学意义[以中位数(25分位数,75分位数)记录为256.5(141.6,585.3)pg/ml比130.2(92.1,256.6)pg/ml,2.90(2.69,3.22)mmol/L比2.61(2.50,2.75)mmol/L,2.23(2.08,2.41)mmol/L比2.12(2.05,2.14)mmol/L,χ^2值分别为7.17、11.90、8.32,P值均<0.05]。术前血钙高于2.62 mmol/L(AUC=0.698,95%CI:0.57~0.83,P=0.006)或术前PTH高于115.9 pg/ml(AUC=0.697,95%CI:0.58~0.82,P=0.007)时患者术后有发生PTH完全性抑制的趋势。结论术前血钙及PTH水平是PHPT术后暂时性PTH抑制的危险因素。Objective To study relative risk factors for temporarily inhibited parathyroid hormone(PTH)secretion after surgery of primary hyperparathyroidism(PHPT).Methods Seventy-two cases with PHPT from October 2017 to March 2019 in Beijing Chaoyang Hospital were analyzed retrospectively,including 22 males and 50 females aged from 13 to 83 years old.They were reviewed and divided into a complete inhibition group(24 cases,PTH=0 pg/ml),an incomplete inhibition group(23 cases,0<PTH<12.4 pg/ml),and a non-inhibition group(25 cases,PTH≥12.4 pg/ml)according to the PTH level on the first day after surgery of PHPT.With the Kruskal-Wallis multi-group rank sum test and the Nemenyi test,preoperative and postoperative biochemical parameters and endocrine indexes,including the preoperative serum levels of calcium,phosphorus,PTH,25-hydroxyvitamin D,and alkaline phosphatase,as well as the levels of PTH 10 min after focal resection,calcium on the first day after surgery,and PTH on the third day after surgery,were compared among three groups to evaluate potential risk factor for postoperative temporary inhabitation of PTH secretion.The predictive values of various risk factors for postoperative temporary inhibition of PTH secretion were evaluated with ROC curve analysis.Results Preoperative serum PTH,calcium levels,and serum calcium level on the first day after surgery in the complete inhibition group were higher than those in the non-inhibition group,respectively,with statically significant differences[256.5(141.6,585.3)pg/ml vs.130.2(92.1,256.6)pg/ml,2.90(2.69,3.22)mmol/L vs.2.61(2.50,2.75)mmol/L,2.23(2.08,2.41)mmol/L vs.2.12(2.05,2.14)mmol/L,χ^2 were 7.17,11.90,8.32,respectively,all P<0.05].When the preoperative serum calcium level was higher than 2.62 mmol/L(AUC=0.698,95%CI:0.57-0.83,P=0.006)or the preoperative PTH level was higher than 115.9 pg/ml(AUC=0.697,95%CI:0.58-0.82,P=0.007),patients tended to inhibit completely PTH secretion after operation.Conclusions Preoperative serum calcium and PTH levels are risk factors for postoperat

关 键 词：原发性甲状旁腺功能亢进症 甲状旁腺激素 并发症 危险因素 

分 类 号：R65[医药卫生—外科学]