继发性甲状旁腺功能亢进患者行甲状旁腺全切除加自体移植术后高钾血症的危险因素分析  

Risk Factors of Hyperkalemia After Total Parathyroidectomy with Autotransplantation in Patients with Secondary Hyperparathyroidism

作　　者：朱帅帅 程广明 王春晖 ZHU Shuaishuai;CHENG Guangming;WANG Chunhui(Department of Hepatobiliary Pancreatic Splenic Thyroid Surgery,General Hospital of Northern Theater Command,Shenyang Liaoning 110016,China)

机构地区：[1]北部战区总医院肝胆胰脾甲状腺外科,辽宁沈阳110016

出　　处：《华南国防医学杂志》2022年第11期884-887,共4页Military Medical Journal of South China

基　　金：辽宁省自然科学基金指导计划(20180551256)。

摘　　要：目的分析继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)患者行甲状旁腺全切除加自体移植术(total parathyroidectomy with autotransplantation,tPTX+AT)后发生高钾血症的危险因素。方法回顾性分析2014-10/2021-10月于作者医院肝胆胰脾甲状腺外科行tPTX+AT的67例SHPT患者病例资料。依据术后血钾水平分为高钾血症组和非高钾血症组,探究SHPT患者术后发生高钾血症的危险因素。绘制受试者工作特征(receiver operating characteristic,ROC)曲线,并选定最佳预测值,计算其敏感度和特异度。结果34例患者术后发生高钾血症,其中男性21例(61.80%),女性13例(38.20%)。单因素分析显示,高钾血症组术前白蛋白、血钾水平显著高于非高钾血症组(P均<0.05)。Logistic回归分析显示,术前血钾是影响患者术后发生高钾血症的独立危险因素(P<0.01)。ROC曲线预测术前血钾对术后发生高钾血症的最佳值为4.60 mmol/L,曲线下面积(area under the curve,AUC)为0.816,敏感度79.41%,特异度87.88%。结论术前血钾水平是SHPT患者接受tPTX+AT后发生高钾血症的独立危险因素。术前控制好血钾水平在4.60 mmol/L以下,可以减少患者术后发生高钾血症的可能性,改善患者的预后。Objective To analyze the risk factors of hyperkalemia in patients with secondary hyperparathyroidism(SHPT)after total parathyroidectomy with autotransplantation(tPTX+AT).Methods The clinical data of 67 SHPT patients who underwent tPTX+AT in the department of hepatobiliary pancreatic splenic thyroid surgery in the author′s hospital from October 2014 to October 2021 were retrospectively analyzed.The patients were divided into hyperkalemia group and non-hyperkalemia group according to the postoperative serum potassium level,and the risk factors of postoperative hyperkalemia were explored.Receiver operating characteristic(ROC)curve was drawn,and the best predictive value was selected to caculate its sensitivity and specificity.Results Among the 67 patients,34 cases had postoperative hyperkalemia,including 21 males(61.80%)and 13 females(38.20%).Univariate analysis showed that the levels of preoperative albumin and preoperative serum potassium in hyperkalemia group were significantly higher than those in non-hyperkalemia group(all P<0.05).Logistic regression analysis showed that preoperative blood potassium was an independent risk factor for postoperative hyperkalemia(P<0.01).ROC curve analysis calculated that the best predictive value of preoperative serum potassium for postoperative hyperkalemia was 4.60 mmol/L,the area under the curve(AUC)was 0.816,sensitivity was 79.41%,specificity was 87.88%.Conclusion Preoperative blood potassium level is a significant independent risk factor for hyperkalemia in SHPT patients after tPTX+AT.Preoperative control of blood potassium level below 4.60 mmol/L can reduce the possibility of postoperative hyperkalemia and improve the prognosis of patients.

关 键 词：继发性甲状旁腺功能亢进 甲状旁腺全切除加自体移植术 高钾血症 血液透析 预后 

分 类 号：R582[医药卫生—内分泌]