原发性甲旁亢患者术后骨饥饿综合征相关危险因素分析  

Risk factors of developing thehungry bone syndrome after parathyroidectomy for primary hyperparathyroidism

作　　者：赵艺凡 冯正平[1] 孔令泉[2] Zhao Yifan;Feng Zhengping;Kong Lingquan(Department of Endocrinology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Breast and Thyroid Surgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院内分泌科,重庆400016 [2]重庆医科大学附属第一医院乳腺甲状腺外科,重庆400016

出　　处：《中华内分泌外科杂志》2023年第4期420-424,共5页Chinese Journal of Endocrine Surgery

基　　金：重庆市医学会科研项目(2012-2-041)。

摘　　要：目的探讨原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)患者行甲状旁腺切除术(parathyroidectomy,PTX)后发生骨饥饿综合征(hungrybone syndrome,HBS)的危险因素。方法回顾性分析2014年4月至2022年4月在重庆医科大学附属第一医院内分泌科及乳腺甲状腺外科住院并行PTX术的104例PHPT患者的临床资料,根据术后是否发生HBS分为:HBS组(n=29)和非HBS组(n=75),采用SPSS 22.0软件进行分析,确定HBS的相关危险因素。结果HBS组术前血白蛋白、血镁、血磷、25(OH)D、髋部骨密度低于非HBS组;术前血钙、血甲状旁腺激素(parathyroid hormone,PTH)、骨转换标志物(骨碱性磷酸酶(bone alkaline phosphatase,BALP)、骨钙素(osteocalcin,OC)、1型原胶原N-端前肽(type I procollagen amino-terminalpeptide,PINP)、1型胶原交联羧基端肽β(β-CarboxyIterm inalpeptide,β-CTX)高于非HBS组(P<0.05)。HBS组及非HBS组术前血钙、BALP、PINP水平分别为[(3.37±0.58)vs(2.91±0.28)mmol/L;38.37(15.59,58.79)vs 18.21(11.28,25.57)μg/L;256.25(139.95,527.95)vs 79.72(50.64,120.33)ng/ml]。HBS的发生与患者术前血钙(0R=15.006,P<0.001)、血PTH(0R=1.002,P<0.001)、血BALP(0R=1.055,P<0.001)、血OC(0R=1.019,P<0.001)、血P1NP(OR=1.008,P<0.001)、血β-CTX(0R=1.816,P=0.006)呈正相关,而与血白蛋白(OR=0.850,P=0.011)、血镁(OR=0.012,P=0.002)、25(OH)D(OR=0.844,P=0.001)、髋部骨密度(OR=0.004,P=0.019)呈负相关。多因素分析提示术前血钙(0R=36.689,P=0.009)、血P1NP(0R=1.019,P=0.022)、血BALP(OR=1.049,P=0.031)是HBS的独立危险因素,受试者工作特征曲线(receiver operating characteristic curve,R0C)示AUC分别为0.7368、0.8326、0.7605,敏感性分别为55.2%、75.9%、72.4%;特异性分别为88.0%、81.3%、78.7%。此外,血P1NP是HBS患者术后静脉钙需求量的独立预测指标(P=0.035)。结论PHPT患者术前血钙>3.22mmol/L、血P1NP>138.80ng/ml或血BALP>26.08μg/L时,术后发生HBS风险显著升高。对术前血P1NP明显升高者,术后可适Objective To determine possible risk factors of developing HBS after parathyroidectomy for PHPT.Methods The clinical data of 104 patients with PHPT who were hospitalized in the First Affiliated Hospi-tal of Chongqing Medical University and underwent PTX surgery from Apr.2014 to Apr.2022 were retrospectively analyzed.There were 36 males and 68 females.105 patient were divided into two groups:HBS group(n=29)and non-HBS group(n=75)according to whether HBS occurred after PTX.The clinical related data of the two groups were collected and analyzed with SPSS 22.0 software to determine the risk factors of HBS.Results Serum albu-min,blood magnesium,blood phosphorus,25(OH)D and hip bone mineral density in HBS group were lower than those in non HBS group;Preoperative blood calcium,blood PTH,bone turnover markers(BALP,OC,PINPβ-CTX)were higher than those in non HBS group(P<0.05).The preoperative serum calcium,BALP,and PINP levels in the HBS group and non HBS group were:(3.37±0.58)vs(2.91±0.28)mmol/L;38.37(15.59,58.79)vs 18.21(11.28,25.57)μg/L;256.25(139.95,527.95)vs 79.72(50.64,120.33)ng/ml.Preoperative serum calcium(0R=15.006,P<0.001),PTH(OR=1.002,P<0.001),BALP(OR=1.055,P<0.001),OC(0R=1.019,P<0.001),PINP(OR=1.008,P<0.001),β-CTX(OR=1.816,P=0.006)were positively correlated with HBS,while serum albumin(OR=0.850,P=0.011),magnesium(0R=0.012,P=0.002),25(OH)D(OR=0.844,P=0.001)and hip BMD(0R=0.00,P=0.019)were negatively correlated with HBS.Preoperative serum calcium(OR=36.689,P=0.009),PINP(OR=1.019,P=0.022)and BALP(OR=1.049,P=0.031)were independent risk factors for HBS.The ROC curves showed that the AUC values were 0.7368,0.8326,and 0.7605,respectively,with sensitivities of 55.2%,75.9%,and 72.4%;the specificities were 88.0%,81.3%and 78.7%.The amount of intravenous calcium supplement in HBS patients was related to preoperative blood BALP and PINP(P=0.035).Conclusions Patients with PHPT have a significantly increased risk of postoperative HBS when preoperative blood calcium>3.22 mmol/L,P1NP>138.80 ng/ml,or BALP>26.08(μg/L).For p

关 键 词：骨饥饿综合征 原发性甲状旁腺功能亢进症 骨代谢标志物 甲状旁腺切除术 

分 类 号：R653[医药卫生—外科学]