BMI对甲状腺全切术后甲状旁腺功能恢复的影响  

Effect of BMI on parathyroid function recovery after total thyroidectomy for thyroid carcinoma patients

作　　者：刘俊松[1] 姚小宝[1] 许崇文[1] 赵谦[1] 赵瑞敏[1] 李宏慧[1] 白艳霞[1] 张少强[1] Liu Junsong;Yao Xiaobao;Xu Chongwen;Zhao Qian;Zhao Ruimin;Li Honghui;Bai Yanxia;Zhang Shaoqiang(Department of Otorhinolaryngology-Head and Neck Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Shaanxi Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院耳鼻咽喉头颈外科,陕西西安710061

出　　处：《现代肿瘤医学》2020年第15期2593-2597,共5页Journal of Modern Oncology

基　　金：陕西省甲状腺疾病临床医学研究中心经费(编号:2017LCZX-03)。

摘　　要：目的:研究体重指数(body mass index,BMI)对甲状腺癌患者行甲状腺全切术后甲状旁腺功能的影响。方法:纳入我科2017年11月至2018年8月期间收住院的甲状腺癌患者,所行术式为甲状腺全切术+单侧或双侧颈中央区淋巴结清扫术,收集患者临床资料,按照BMI<24 kg/m 2(正常组,193例)、24≤BMI<28 kg/m 2(超重组,130例)和BMI≥28 kg/m 2(肥胖组,32例)分组,比较三组患者术后甲状旁腺激素(parathyroid hormone,PTH)减低、恢复及低血钙发生情况。结果:三组患者在年龄、肿瘤直径、中央区淋巴结清扫范围(单侧或双侧)、是否合并甲亢或慢性甲状腺炎、术前血钙、误切甲状旁腺方面无显著差异(P>0.05)。三组患者术前血清PTH分别为(44.2±16.6)pg/ml、(48.1±18.9)pg/ml、(53.7±19.9)pg/ml,其中肥胖组与正常组之间的差异具有统计学意义(P=0.011)。BMI与血清PTH之间呈正相关,Spearman相关系数为0.184(P=0.001)。三组患者术后均出现明显的血清PTH下降,术后第1天血清PTH水平较术前平均下降幅度均为60%左右,三组降幅之间无显著差异(P=0.795)。三组患者术后第1天、1月、半年的血清PTH水平降至15 pg/ml以下的比例无显著差异(P>0.05)。当患者术后第1天血清PTH>7 pg/ml时,术后1月血清PTH水平全部恢复至15 pg/ml以上。术后第1天、1月及半年,三组患者之间低血钙的发生率均无显著差异(P>0.05)。结论:BMI与血清PTH呈正相关,肥胖者血清PTH水平较正常者显著升高,但肥胖并不影响甲状腺癌患者行甲状腺全切术+中央区淋巴结清扫术后甲状旁腺激素水平的降低幅度和恢复。Objective:To evaluate the effect of body mass index(BMI)on parathyroid function recovery after total thyroidectomy for thyroid carcinoma patients.Methods:Patients undergoing total thyroidectomy plus central neck dissection(CND)between November 2017 and August 2018 at the department of otorhinolaryngology-head and neck surgery,the First Affiliated Hospital of Xi'an Jiaotong University,were enrolled in analysis.Demographic and clinical data were collected.Patients were divided into normal control group(BMI<24 kg/m2),overweight group(24≤BMI<28 kg/m2)and obesity group(BMI≥28 kg/m2)according to BMI value.The postoperative parathyroid hormone(PTH)decline and recovery,and hypocalcemia rate were compared among three groups.Results:There were no significant differences in age,tumor size,extent of CND,concomitant thyroiditis or hyperthyroidism,preoperative serum calcium and inadvertent parathyroidectomy among three groups(P>0.05).BMI was correlated positively with serum PTH with the Spearman index at 0.184(P=0.001).The serum PTH levels in overweight and obesity group patients were significantly higher than that in normal control group[(44.2±16.6)pg/ml vs(48.1±18.9)pg/ml vs(53.7±19.9)pg/ml,P<0.05]with the increase of BMI values.The serum PTH levels decreased obviously after operation by(59.4±24.8)%,(60.6±24.5)%and(62.7±21.8)%in three groups respectively but without statistical difference(P=0.795).The percentages of serum PTH level less than 15 pg/ml in different groups at day 1,one month and half year postoperatively did not differ among three groups(P=0.951).The serum PTH at one month postoperatively recovered to over 15 pg/ml in all those patients whose serum PTH were over 7 pg/ml at one day postoperatively.The rates of postoperative hypocalcemia among different groups were not significantly different after operation,respectively,regardless of time points.Conclusion:BMI was correlated positively with serum PTH.Obesity patients presented higher serum PTH levels than normal control patients.But obesity did not aff

关 键 词：体重指数 肥胖 甲状腺癌 甲状旁腺激素 甲状腺全切术 

分 类 号：R736.1[医药卫生—肿瘤]