iPTH、25(OH)D水平与甲状腺切除术后甲状旁腺功能暂时性减退的关系及影响因素研究  

A Study of the Relationship Between iPTH,25(OH)D Levels and TemporaryHypoparathyroidism After Thyroidectomy and Its Influencing Factors

作　　者：高峰 吕金 王子斌 卢伟燕 姜玉石 GAO Feng;LYU Jin;WANG Zibin;LU Weiyan;JIANG Yushi(General Surgery,Hebei PetroChina Central Hospital,Langfang 065000,China)

机构地区：[1]河北中石油中心医院普通外科,河北廊坊065000

出　　处：《标记免疫分析与临床》2023年第5期811-816,共6页Labeled Immunoassays and Clinical Medicine

基　　金：河北省廊坊市科学技术研究与发展计划项目(编号:2021013153)。

摘　　要：目的探讨甲状旁腺素(iPTH)、25-羟基维生素D[25(OH)D]水平与甲状腺切除术后甲状旁腺功能暂时性减退的关系及影响因素。方法选取2021年1月至2022年7月在我院治疗的甲状腺切除术术后发生甲状旁腺功能暂时性减退患者52例作为观察组,同时选取术后未发生甲状旁腺功能暂时性减退患者104例作为对照组,比较两组临床资料、手术前后iPTH、25(OH)D差异,采用Logistic回归分析发生甲状旁腺功能暂时性减退的影响因素,分析iPTH变化值、术前25(OH)D预测发生甲状旁腺功能暂时性减退的价值。结果观察组合并桥本甲状腺炎、甲状腺全切、包膜侵犯、Ⅵ区淋巴结清扫、甲状旁腺自体移植比例分别为65.38%、69.23%、55.77%、67.31%和73.08%,明显高于对照组(P<0.05)。观察组术后iPTH为20.22±5.65pg/mL,明显低于对照组(P<0.05),而iPTH变化值为17.12±3.34pg/mL,明显高于对照组(P<0.05)。观察组术前、术后25(OH)D分别为17.82±3.22ng/mL和17.29±3.14ng/mL,明显低于对照组(P<0.05)。观察组和对照组25(OH)D变化值比较差异无统计学意义(P>0.05)。Ⅵ区淋巴结清扫、iPTH变化值、术前25(OH)D是发生甲状旁腺功能暂时性减退的影响因素(P<0.05)。iPTH变化值、术前25(OH)D预测发生甲状旁腺功能暂时性减退的ROC曲线下面积分别为0.916(95%CI 0.869~0.962)和0.867(95%CI 0.869~0.962),P<0.05。结论甲状腺切除术术后甲状旁腺功能暂时性减退发生受Ⅵ区淋巴结清扫、iPTH变化值、术前25(OH)D的影响,iPTH变化值及术前25(OH)D预测甲状旁腺功能暂时性减退发生有一定应用价值。Objective To investigate the relationship between levels of parathyroid hormone(iPTH),25 hydroxyvitamin D[25(OH)D]and the temporary hypoparathyroidism after thyroidectomy and the influencing factors.Methods 52 patients with temporary hypoparathyroidism after thyroidectomy treated in our hospital from January,2021 to July,2022 were selected as the observation group,while 104 patients without temporary hypoparathyroidism after thyroidectomy were selected as the control group.The clinical data,iPTH and 25(OH)D before and after operation were compared between the two groups,Logistic regression was used to analyze the influencing factors of temporary hypoparathyroidism,and to analyze the value of iPTH changes and preoperative 25(OH)D in predicting temporary hypoparathyroidism.Results The proportions of Hashimoto’s thyroiditis,total thyroidectomy,capsule invasion,lymph node dissection in zone VI,and parathyroid autotransplantation in the observation group were 65.38%,69.23%,55.77%,67.31%,and 73.08%,respectively,which were significantly higher than those in the control group(P<0.05).The postoperative iPTH of the observation group was 20.22±5.65 pg/mL,which was significantly lower than that of the control group(P<0.05),while the changing value of iPTH was 17.12±3.34pg/mL,which was significantly higher than that of the control group(P<0.05).25(OH)D before and after operation in the observation group were 17.82±3.22 ng/mL and 17.29±3.14ng/mL,respectively,which were significantly lower than those in the control group(P<0.05).There was no significant difference in the changing value of 25(OH)D between the observation group and the control group(P>0.05).Regional VI lymph node dissection,iPTH changing value and preoperative 25(OH)D were the influencing factors of temporary hypoparathyroidism(P<0.05).The area under ROC curve predicted by iPTH changing value and preoperative 25(OH)D for temporary hypoparathyroidism was 0.916(95%CI 0.869-0.962)and 0.867(95%CI 0.869-0.962),respectively,(P<0.05).Conclusion The occurrence of t

关 键 词：甲状旁腺激素 25-羟基维生素D 甲状腺切除术 甲状旁腺功能暂时性减退 影响因素 

分 类 号：R582.2[医药卫生—内分泌]