肾性继发性甲状旁腺功能亢进症患者手术后严重低钙血症的危险因素  

The risk factors of severe hypocalcemia in patients with renal secondary hyperparathyroidism after parathyroidectomy

作　　者：陈丹 赵文曼 王雪荣[1] 王德光[1] CHEN Dan;ZHAO Wen-man;WANG Xue-rong;WANG De-guang(Department of Nephrology,the Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院肾脏内科,合肥230601

出　　处：《中国血液净化》2022年第8期559-563,共5页Chinese Journal of Blood Purification

基　　金：安徽医科大学临床科学基金项目(2021xkj165);高校优秀青年骨干人才国外访学研修项目(gxgwfx2021013);高校自然科学研究重点项目(KJ2021A0314)。

摘　　要：目的探讨肾性继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)患者手术后严重低钙血症的危险因素。方法纳入784例接受了甲状旁腺全切除术+自体移植术(total parathyroidectomy with autologous transplantation,TPTX+AT)或甲状旁腺全切术(total parathyroidectomy,TPTX)的肾性SHPT患者病例,进行回顾性分析。根据患者手术后1天血清校正钙水平是否低于1.8mmol/L分为严重低钙组与非严重低钙组。结果甲状旁腺切除术(parathyroidectomy,PTX)后27.3%(214例)的患者手术后1天出现严重低钙血症。严重低钙组和非严重低钙组比较,年龄(t=5.648,P<0.001)、透析龄>5年(Z=7.199,P=0.007)、腹膜透析(χ^(2)=4.985,P=0.026)、手术前低钙血症(χ^(2)=6.241,P=0.012)、手术前甲状旁腺激素(parathyroid hormone,PTH)(Z=-8.902,P<0.001)、手术前碱性磷酸酶(alkaline phosphatase,ALP)(Z=-10.230,P<0.001)、手术后血磷达标(χ^(2)=3.988,P=0.046)差异有统计学意义。多因素Logistic回归分析示:年龄较小(OR=0.963,95%CI:0.945~0.980,P<0.001)、手术前低钙血症(OR=1.930,95%CI:1.120~3.327,P=0.018)、手术前PTH较高(OR=1.0004,95%CI:1.000~1.001,P=0.016)、手术前ALP较高(OR=1.001,95%CI:1.000~1.001,P=0.001)是肾性SHPT患者手术后严重低钙血症的独立危险因素。结论越年轻、手术前低钙血症、手术前ALP越高、手术前PTH越高的SHPT患者在TPTX+AT术或TPTX术后更易出现严重低钙血症。Objective To explore the risk factors of severe hypocalcemia in patients with renal secondary hyperparathyroidism(SHPT)after parathyroidectomy(PTX).Methods A retrospective study was conducted on 784 patients with renal SHPT who underwent total parathyroidectomy and autologous transplantation(TPTX+AT)or total parathyroidectomy(TPTX).Patients were divided into severe hypocalcemia group(corrected serum calcium<1.8 mmol/L)and non-severe hypocalcemia group(corrected serum calcium≥1.8mmol/L)according to the serum calcium level at the first day after operation.Results There were 214 cases(27.3%)with severe hypocalcemia at the first day after PTX.Age(t=5.648,P<0.001),dialysis age>5years(Z=7.199,P=0.007),peritoneal dialysis(χ^(2)=4.985,P=0.026),preoperative hypocalcemia(χ^(2)=6.241,P=0.012),preoperative parathyroid hormone(PTH)level(Z=-8.902,P<0.001),preoperative alkaline phosphatase(ALP)level(Z=-10.230,P<0.001)and postoperative serum phosphorus reached the standard level(χ^(2)=3.988,P=0.046)were different between severe hypocalcemia group and non-severe hypocalcemia group.Multivariate logistic regression showed that younger age(OR=0.963,95%CI 0.945~0.980,P<0.001),preoperative hypocalcemia(OR=1.930,95%CI 1.120~3.327,P=0.018),preoperative higher PTH level(OR=1.0004,95%CI1.000~1.001,P=0.016)and preoperative higher ALP level(OR=1.001,95%CI 1.000~1.001,P=0.001)were the independent risk factors of severe hypocalcemia in renal SHPT patients after PTX.Conclusion Patients with younger age,preoperative hypocalcemia,higher preoperative ALP,and higher preoperative PTH level are more likely to develop severe hypocalcemia after TPTX+AT or TPTX.

关 键 词：低钙血症 继发性甲状旁腺功能亢进症 甲状旁腺切除术 甲状旁腺激素 碱性磷酸酶 

分 类 号：R582[医药卫生—内分泌]