甲状腺术后甲状旁腺激素下降率对永久性甲状旁腺功能低下的预测价值研究  

Predictive value of parathyroid hormone decline rate for permanent hypoparathyroidism after thyroidectomy

作　　者：陈紫巍 仇玉轩 邢志超 木尼热·阿不都外力 苏安平[1] Chen Ziwei;Qiu Yuxuan;Xing Zhichao;Munire Abuduwaili;Su Anping(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4期406-410,共5页Chinese Journal of Endocrine Surgery

基　　金：四川省科技厅资助项目(2021YFS0103)。

摘　　要：目的探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)术后1个月甲状旁腺激素(parathyroid hormone,PTH)下降率,预测永久性甲状旁腺功能低下(permanent hypoparathyroidism,PHP)的价值。方法回顾性研究2013年1月至2018年6月在四川大学华西医院甲状腺外科322例初次至少行甲状腺全切+单侧中央区淋巴结清扫术的PTC患者的临床资料,女257例,男65例,根据PTH恢复正常的时间分为暂时性甲状旁腺功能低下(temporary hypoparathyroidism,THP)组和PHP组。统计术后1个月PTH下降率及甲状旁腺功能低下发生情况,观察临床特征及手术信息,分析PHP发生的危险因素。采用SPSS 23.0统计学软件进行数据处理。THP及PHP使用χ^(2)检验及t检验进行组间比较。对相关因素行多因素Logistic回归分析。结果纳入THP 307例,PHP 15例。多因素Logistic分析年龄≥55岁(OR=35.193,95%CI 2.936~421.870,P=0.005)、术前PTH值越接近正常低限(OR=2.349,95%CI 1.161~4.755,P=0.018)是PHP发生的独立危险因素。PHP的患者术后1个月PTH下降率更高(OR=373.439,95%CI=26.568~5248.983,P=0.000)。ROC曲线提示以术后1个月PTH下降率截断值73.2%预测PHP的敏感度为86.7%,特异度为94.8%。结论PTC患者年龄≥55岁、术前PTH越接近正常低限是PHP发生的独立危险因素,术后1个月PTH下降率超过73.2%可预测PHP。Objective To investigate the value of the decrease rate of parathyroid hormone(PTH)in predicting permanent hypoparathyroidism(PHP)in one month after operation of papillary thyroid carcinoma(PTC).Methods The clinical data of 322 patients with PTC who underwent at least total thyroidectomy and unilateral central lymph node dissection in the Thyroid Surgery Center of West China Hospital of Sichuan University from Jan.2013 to Jun.2018 were retrospectively analyzed.There were 257 women and 65 men.According to the time when PTH returned to normal,they were divided into 307 cases in the temporary hypoparathyroidism(THP)group and 15 cases in the PHP group.The decrease rate of PTH and the incidence of hypoparathyroidism in one month after operation were counted,the clinical characteristics and operation information were observed,and the risk factors of PHP were analyzed.SPSS 23.0 statistical software was used for data processing.χ^(2) test and t test were used for comparison between THP and PHP.The related factors were analyzed by multivariate logistic regression.Results 307 cases of THP and 15 cases of PHP were included.Multivariate logistic analysis showed that age≥55 years old(OR,35.193;95%CI,2.936-421.870;P=0.005)and PTH before operation closer to normal lower limit(OR,2.349;95%CI,1.161-4.755;P=0.018)were independent risk factors for PHP.Patients with PHP had a higher rate of PTH decline in 1 month after operation(OR,373.439;95%CI,26.568-5248.983;P=0.000).The ROC curve showed that the sensitivity and specificity of predicting PHP were 86.7%and 94.8%respectively.Conclusions The age of patients with PTC≥55 years old and PTH before operation closer to normal lower limit are independent risk factors for the occurrence of PHP.The decline rate of PTH in one month after operation which more than 73.2%can predict PHP.

关 键 词：甲状腺乳头状癌 甲状旁腺功能低下 预测模型 甲状腺癌 

分 类 号：R736.1[医药卫生—肿瘤]