甲状腺术后症状性低钙血症的危险因素分析  

Analysis of risk factors for symptomatic hypocalcemia after thyroid surgery

作　　者：王晨一 代权伟 李建华[1,2] 付利军 郑守华[1,2] 邱新光 Wang Chenyi;Dai Quanwei;Li Jianhua;Fu Lijun;Zheng Shouhua;Qiu Xinguang(Second Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450002,China;International Joint Laboratory of Thermal Ablation of Thyroid Nodules in Henan Province,Zhengzhou 450002,China)

机构地区：[1]郑州大学第一附属医院甲状腺外二科,450002 [2]河南省甲状腺结节热消融国际联合实验室,郑州450002

出　　处：《国际外科学杂志》2021年第3期179-184,F0004,共7页International Journal of Surgery

基　　金：2020年医学科技攻关(重点)项目(SBGJ202002040)。

摘　　要：目的观察甲状腺术后患者症状性低钙血症(SH)的发生与多种潜在影响因素之间的关系,根据甲状腺切除范围进行分层并探讨全段甲状旁腺激素(iPTH)对术后SH的预测价值。方法回顾性选取2020年1月—2021年2月郑州大学第一附属医院收治的3379例甲状腺术后患者中发生SH的122例患者,设为SH组。用系统抽样法抽取同年余3200例中未发生SH的100例患者,设为对照组。用Pearson相关性分析评估两组患者的年龄、术前钙、术后钙、术前iPTH、术后iPTH、中央区淋巴结数目、出血量、手术时间、性别、淋巴结清扫方式、甲状腺切除范围、术后病理类型等潜在影响因素。正态分布的计量资料以均数±标准差(Mean±SD)表示,组间比较采用t检验;计数资料组间比较采用χ^2检验。通过绘制受试者操作特征曲线(ROC)研究术前/术后(不同术式)SH组和对照组患者的iPTH水平,预测其iPTH诊断临界值,灵敏度及特异度。结果3379例甲状腺术后患者中,发生SH者122例,发病率为3.6%。SH组和对照组的性别(SH组:男8例,女114例;对照组:男27例.女73例),是否行侧区清扫(SH组:清扫58例,非清扫64例;对照组:清扫7例,非清扫93例),甲状腺切除范围(SH组:单侧14例,双侧108例;对照组:单侧73例,双侧27例).年龄(40.1岁比43.2岁),中央区淋巴结清扫数目(8.6枚比4.6枚),颈侧区淋巴结清扫数目(12.3枚比0.7枚)出血量(22.8 mL比11.0 mL),手术时间(1.7 h比0.8 h),术后iPTH(16.4 pe/mL比41.9 pg/mL),术前iPTH(39.4 pg/mL比47.8 pg/mL)和术后钙水平(1.9 mmol/L比2.2 mmol/L)比较,差异具有统计学意义(P<0.05)。而两组患者的术后病理类型(SH组:毒性甲状腺肿4例,甲状腺髓样癌3例,甲状腺滤泡癌1例,甲状腺乳头状癌114例;对照组:甲状腺髓样癌1例,甲状腺滤泡癌1例,甲状腺乳头状癌98例。P=0.25)及术前钙(2.3 mmol/L比2.3 mmol/L,P=0.10)之间差异无统计学意义。甲状腺双侧切除患者的术后iPTH若<20.08Objective To observe the relationship between the occurrence of symptomatic hypocalcemia(SH)and various potential influencing factors in patients after thyroidectomy,stratify according to the scope ofthyroidectomy,and explore the predictive value of intact parathyroid hormone(iPTH)for postoperative SH.Methods Among 3379 patients with thyroidectomy who admitted into the First Affiliated Hospital of ZhengzhouUniversity from January 2020 to February 2021,122 patients with SH after thyroidectomy were collectedretrospectively and set as SH group.100 patients of the remaining 3200 patients who did not suffer from SH in thesame year were selected by systematic sampling method and set as control group.Pearson correlation analysis wasused to analyze the potential influencing factors such as age,preoperative calcium,postoperative calcium,ptreoperative iPTH,postloperative iPTH,central lynuph node number,blood loss,operation duration,gender,lymphnode dissection methol,thy roidectomy range,postoperative patbological type and other.Amosng them,themreasurement data of normal distribution were expresed by mean+stanodard deviatin(Mean±SD),t-test was used for the eomparison between the two groupe,and Chi-square test was used for eount data.By trawing the necriveroperating characteristie curve(ROC),the iPTH levels in puatients with and without SH before/after peration(different surgical methods)were studlied,and the dliagrsoetic threshold,sensitivity and specificity of iPTH werepeedicted.Results Among 3379 patients,122 patients suffered from SH after thy roidlectomy,with the incitencerale of 3.6%,There were significant dlillerences in gendker(8 msales ansdl 114 females in SH group;27 males and73 females in control group),whethber lateral urea dissection was perfotmed(58 cases with dissexction and 64 caseswithaut dissection in SH proup;7 cases with dissection and 93 cases without disection in control group).thayroidectoeny range(14 cases with ane side and 108 cases with both sides in SH group;73 camses with one sidle and 27 cases w

关 键 词：甲状腺 甲状旁腺素 钙 低钙血症 危险因素 

分 类 号：R653[医药卫生—外科学]