术前25-羟基维生素D缺乏对甲状腺乳头状癌术后甲状旁腺功能的影响  

Effect of preoperative 25 hydroxyvitamin D deficiency on posoperative parathyroid function in patients with papillary thyroid cancer

作　　者：木尼热·阿不都外力 夏宝莹 邢志超 苏安平[1] 朱精强[1] Munire Abuduwaili;Xia Baoying;Xing Zhichao;Su Anping;Zhu Jingqiang(Center of Thyroid&Parathyroid Surgery,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院甲状(旁)腺疾病外科诊疗中心,成都610041

出　　处：《中华内分泌外科杂志》2022年第1期32-36,共5页Chinese Journal of Endocrine Surgery

基　　金：四川省科技厅资助项目 (2021YFS0103)。

摘　　要：目的探讨术前25-羟基维生素D[25(OH)D]水平对甲状腺乳头状癌(papillary thyroid carcinoma,PTC)患者术后甲状旁腺功能的影响。方法回顾性分析四川大学华西医院甲状腺外科2017年6月至2019年9月行甲状腺全切+中央区淋巴结清扫(包含侧区淋巴结清扫)的PTC患者426例,女313例,男113例,根据术前25(OH)D水平≤20 ng/ml、>20 ng/ml分为VitD缺乏(vitamin D deficient,VDD)组(n=297)和正常组(n=129)。采用SPSS 23.0统计学软件进行数据处理。对术后临床型甲状旁腺功能减退(简称"甲旁减"),生化型暂时性和生化型永久性甲旁减采用Pearsonχ^(2)检验或Fisher精确检验行组间比较。对术后生化型暂时性和生化型永久性甲旁减的相关因素行单因素和多因素Logistic回归分析。结果术前25(OH)D水平与术后生化型暂时性甲旁减显著相关(P=0.039,OR=1.11)。术前VDD致术后生化型暂时性甲旁减发生风险增加6.67倍(P=0.031,OR=6.67)。术前VDD与术后早期临床型甲旁减无显著相关性(2.7%vs 3.9%,P=0.549)。结论术前对25(OH)D缺乏的患者及时纠正,或可减少因25(OH)D缺乏而造成的术后暂时性甲旁减。Objective To investigate the effect of 25 hydroxyvitamin D[25(OH)D]on postoperative parathyroid function in patients with papillary thyroid carcinoma(PTC).Methods 426 patients who diagnosed as PTC and underwent at least total thyroidectomy plus central lymph node dissection(including lateral lymph node dissection)in Center of Thyroid and Parathyroid Surgery of West China Hospital,Sichuan University,from Jun.2017 to Sep.2019 were retrospectively analyzed.Among them,313 were women and 113 were men,they were divided into vitamin D deficient(VDD)group(n=297)and normal group(n=129)according to preoperative 25(OH)D levels≤20ng/ml and>20ng/ml.SPSS 23.0 statistical software was used for data processing.Pearsonχ^(2) test or Fisher exact test were used to compare the incidence of clinical hypoparathyroidism,biochemical temporary and biochemical permanent hypoparathyroidism between the two groups.Univariate and multivariate logistic regression analysis were used to analyze the related factors of postoperative hypoparathyroidism between the two groups.Results Preoperative 25(OH)D level was significantly correlated with postoperative biochemical temporary hypoparathyroidism(P=0.04,OR=1.11).Compared with patients with adequate preoperative vitamin D,preoperative vitamin D deficiency increased the risk of biochemical transient hypoparathyroidism by 6.67 times(P=0.03;OR=6.67).There was no significant correlation between preoperative vitamin D deficiency and early postoperative clinical hypoparathyroidism(2.7%vs 3.9%,P=0.55).Conclusion Correction of vitamin D deficiency before operation may reduce the incidence of postoperative temporary hypoparathyroidism caused by 25(OH)D deficiency.

关 键 词：25-羟基维生素D 甲状腺术后甲状旁腺功能减退 甲状腺乳头状癌 

分 类 号：R653[医药卫生—外科学] R736.1[医药卫生—临床医学]