透析患者继发性甲状旁腺功能亢进术后早期低钙血症的危险因素  

Risk factors for early hypocalcemia after total parathyroidectomy in dialysis patients with secondary hyperparathyroidism

作　　者：陈思瑜 潘斌 雷欣 陈江华 张萍 CHEN Siyu;PAN Bin;LEI Xin;CHEN Jianghua;ZHAGN Ping(Department of Nephrology,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属第一医院肾脏病中心、浙江省肾脏病防治技术研究重点实验室、国家临床重点专科、浙江大学肾脏病研究所、浙江省肾脏与泌尿系统疾病临床医学研究中心,杭州310003

出　　处：《肾脏病与透析肾移植杂志》2023年第3期214-219,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的:回顾性分析继发性甲状旁腺功能亢进(SHPT)的透析患者行甲状旁腺全切+前臂自体移植(TPTX+AT)后早期低钙血症的患病率及潜在危险因素。方法:选取2015年11月至2018年11月在浙江大学医学院附属第一医院接受TPTX+AT治疗的SHPT患者254例。收集患者术前和术后的血清钙、磷、甲状旁腺激素(PTH)、碱性磷酸酶(ALP)等指标,采用Logistic回归分析评估术后低钙血症危险因素。结果:254例患者中107例(42.13%)发生低钙血症。根据术后1周是否发生低钙血症将患者分为两组,低钙血症组血液透析患者比例高达82%,而非低钙血症组仅65%(P<0.01)。多因素Logistic回归分析显示,血液透析方式(OR=2.155,95%CI 1.164~3.991,P=0.015),PTH≥1656 ng/L(OR=1.771,95%CI 1.021~3.072,P=0.042),ALP≥242 U/L(OR=1.739,95%CI 1.002~3.018,P=0.049)是SHPT患者TPTX+AT术后1周发生低钙血症的独立危险因素。结论:低钙血症是PTX术后常见的并发症。术前高ALP、高PTH及接受维持性血液透析患者其术后更易发生低钙血症。Objective:We aim to identify the prevalence and potential risk factors of early hypocalcemia in patients with secondary hyperparathyroidism(SHPT)after total parathyroidectomy plus forearm autotransplantation(TPTX+AT)retrospectively.Methodology:Patients with SHPT underwent TPTX+AT in our center from November 2015 to November 2018 were reviewed.Preoperative and postoperative laboratory values including serum calcium,phosphorus,parathyroid hormone(PTH)and alkaline phosphatase(ALP)were collected.Logistic stepwise regression with the forward selection of variables was adopted to evaluate the independent variables as predictors of hypocalcemia.Results:Among all 254 patients,hypocalcemia episodes occurred in 107 patients(42.13%).When patients were divided into two groups according to whether hypocalcemia occurred postoperatively,the proportion of hemodialysis patients was as high as 82%in the Hypocalcemia Group while only 65%in the Non-hypocalcemia Group(P<0.01).Multivariate logistic regression analysis showed that the hemodialysis modality(OR=2.155,95%CI 1.164~3.991;P=0.015)and PTH≥1656(OR=1.771,95%CI 1.021~3.072;P=0.042),ALP≥242(OR=1.739,95%CI 1.002~3.018;P=0.049)were the independent risk factor of hypocalcemia 1 week after of TPTX+AT.Conclusion:Patients with high ALP,high PTH preoperatively and undergoing maintenance hemodialysis are more likely to occur hypocalcemia after PTX who should be monitored closely and given more attention.

关 键 词：透析 继发性甲状旁腺功能亢进 甲状旁腺切除术 低钙血症 危险因素 

分 类 号：R653[医药卫生—外科学]