维持性血液透析继发性甲状旁腺功能亢进患者甲状旁腺切除术后低钙血症的危险因素分析  

Risk factors for hypocalcemia after parathyroidectomy in maintenance hemodialysis patients with secondary hyperparathyroidism

作　　者：成铭 黄碧红[1] 陶冶 范春燕 张炜晨 王红鹰 陈靖[1] 张敏敏[1] Cheng Ming;Huang Bihong;Tao Ye;Fan Chunyan;Zhang Weichen;Wang Hongying;Chen Jing;Zhang Minmin(Division of Nephrology,Huashan Hospital,Fudan University,Shanghai 200040,China;Division of General Surgery,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院肾脏科,上海200040 [2]复旦大学附属华山医院普外科,上海200040

出　　处：《中华肾脏病杂志》2022年第5期397-405,共9页Chinese Journal of Nephrology

基　　金：国家自然科学基金(81870501);上海市科学技术委员会基金(19411967800)。

摘　　要：目的探讨继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)维持性血液透析患者接受甲状旁腺切除术(parathyroidectomy,PTX)后补钙量与临床指标的相关性、术后发生低钙血症的危险因素以及PTX术后补钙量对患者远期预后的影响。方法本研究为单中心回顾性研究,入选2014年10月至2021年3月因SHPT在复旦大学附属华山医院接受PTX的维持性血液透析患者为研究对象,手术方式为甲状旁腺全切除+前臂自体移植术或甲状旁腺全切除术。根据术后第1周内补钙量分为补钙量高于均值组(>16.05 g/周)和低于均值组(≤16.05 g/周);根据术后第1周平均血钙水平分为低钙组(≤2.1 mmol/L)与非低钙组(>2.1 mmol/L),比较两组患者间临床指标的差异。Pearson或Spearman相关分析临床指标与术后第1周补钙量的相关性。Logistic回归分析法分析患者术后发生低钙血症的影响因素。Kaplan-Meier法绘制生存曲线,Log-rank检验比较两组患者累积生存率的差异。结果98例血液透析合并SHPT患者入选本研究,患者PTX术后血钙、血磷及血甲状旁腺素(iPTH)水平较术前显著下降(均P<0.05)。多元线性回归分析结果显示,年龄(β=-0.160,P=0.030)与术后第1周补钙量呈负相关,术前iPTH(β=0.004,P=0.025)和C反应蛋白(β=0.186,P=0.011)与术后第1周补钙量呈正相关。Logistic回归分析结果提示,术前血碱性磷酸酶升高(OR=1.002,95%CI 1.000~1.004,P=0.018)和血红蛋白降低(OR=0.977,95%CI 0.954~1.000,P=0.048)是患者术后发生低钙血症的独立影响因素。术后第1周补钙量高于均值组患者SHPT复发率高于补钙量低于均值组(10.26%比0,P=0.023),两组全因死亡率的差异无统计学意义(17.95%比5.08%,P=0.086)。低钙组与非低钙组患者SHPT复发率的差异无统计学意义(8.3%比1.8%,P=0.451),两组全因死亡率的差异亦无统计学意义(12.5%比12.7%,P=1.000)。Kaplan-Meier生存曲线结果显示,低钙组与非低钙组患者累�Objective To explore the risk factors of hypocalcemia and the correlation between calcium supplementation and clinical parameters after parathyroidectomy(PTX)in maintenance hemodialysis patients with secondary hyperparathyroidism(SHPT),and to analyze the effect of calcium supplementation after PTX on the long-term prognosis of patients.Methods This study was a single-center retrospective study.The patients who underwent PTX in maintenance hemodialysis patients with SHPT in the Huashan Hospital affiliated to Fudan University from October 2014 to March 2021 were retrospectively enrolled.Total PTX with auto transplantation or total PTX alone were the surgical procedures.According to the postoperative requirement of calcium in the first week,the patients were divided into two groups:high calcium supplement(>16.05 g/week)group and low calcium supplement group(≤16.05 g/week).According to the average serum calcium level in the first week after operation,the patients were divided into hypocalcemia group(≤2.1 mmol/L)and non-hypocalcemia group(>2.1 mmol/L)and the differences of clinical parameters between the two groups were compared.The correlation between clinical parameters and the postoperative calcium requirement was examined through Pearson or Spearman correlation analysis.The influencing factors for hypocalcemia after PTX were examined through logistic regression analysis.The survival curve was made by Kaplan-Meier method,and the difference of cumulative survival rate between the two groups was compared by log-rank test.Results A total of 98 maintenance hemodialysis patients with SHPT were enrolled.The levels of serum calcium,phosphorus,and intact parathyroid hormone(iPTH)after the operation decreased significantly than those of preoperation(all P<0.05).Multiple linear regression analysis showed age(β=-0.160,P=0.030),iPTH(β=0.004,P=0.025)and C-reactive protein(β=0.186,P=0.011)were correlated with postoperative calcium requirement.Preoperative alkaline phosphatase(OR=1.002,95%CI 1.000-1.004,P=0.018)and hemoglo

关 键 词：甲状旁腺功能亢进症 继发性 甲状旁腺切除术 低钙血症 饥饿骨综合征 

分 类 号：R692.5[医药卫生—泌尿科学] R653[医药卫生—外科学]