肾性继发性甲状旁腺功能亢进患者行甲状旁腺全切联合自体移植术后早期发生低钙血症的危险因素分析  

Risk factors for early hypocalcemia after total parathyroid resection combined with autologous transplantation in patients with renal secondary hyperparathyroidism

作　　者：丁亚磊 纪飞虹 高铭 孙琦璇 邱新光[1] Ding Yalei;Ji Feihong;Gao Ming;Sun Qixuan;Qiu Xinguang(Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院甲状腺外科,郑州450052

出　　处：《河南外科学杂志》2023年第5期16-20,共5页Henan Journal of Surgery

摘　　要：目的探讨甲状旁腺全切除+自体移植术(tPTX+AT)术后早期发生低钙血症的危险因素。方法回顾性分析2015-07—2022-06郑州大学第一附属医院行tPTX+AT治疗的继发性甲状旁腺功能亢进(SHPT)患者的临床资料。男88例,女66例,年龄(44.2±10.24)岁(范围:32~71岁)。透析时长(7.41±2.81)a(范围:4~11 a)。记录患者的性别、透析时间、伴有症状(骨痛、皮肤瘙痒、身高缩短)等有关信息,进行单因素和多因素分析,以确定术后低钙血症的独立危险因素。并运用受试者工作特征(ROC)曲线对这些因素进行验证。结果全组154例患者中91例出现低钙血症。单因素分析结果显示:身高缩短、术前甲状旁腺激素(PTH)、碱性磷酸酶(ALP)、血钙、血红蛋白(Hb)、白蛋白(Alb)是术后发生低钙血症的危险因素。多因素分析结果显示:术前PTH>2192 pg/mL、ALP>299.5 U/L是术后发生低钙血症的独立危险因素,术前血钙>2.33 mmol/L是术后低钙血症的独立保护因素。术前PTH与ALP的曲线下面积(AUC)分别为0.740(95%CI为0.662~0.819)、0.764(95%CI为0.688~0.840),差异均有统计学意义(P<0.05)。结论术前PTH、ALP是术后发生低钙血症的独立危险因素,术前血钙水平是术后发生低钙血症的独立保护因素。Objective To investigate the risk factors for early hypocalcemia after total parathyroid resection+autografting(tPTX+AT).Methods A retrospective analysis was conducted for patients with secondary hyperparathyroidism(SHPT)who underwent such surgery in the First Affiliated Hospital of Zhengzhou University from July 2015 to June 2022,and univariate and multivariate analysis were performed on the clinical data of these patients to determine the independent risk factors for postoperative hypocalcemia.These factors were verified using the receiver operating characteristic(ROC)curve.Results In the whole group,91 of the 154 patients developed low calcium.In univariate analysis,shortened height,preoperative parathyroid hormone(PTH),alkaline phosphatase(ALP),serum calcium,hemoglobin(Hb),and albumin(Alb)were risk factors for postoperative hypocalcemia.In multivariate analysis,preoperative PH>2192 pg/mL and ALP>299.5 U/L were independent risk factors for postoperative hypocalcemia,and preoperative calcium>2.33mmol/L were independent protective factors for postoperative hypocalcemia.The area under the curve(AUC)of preoperative PTH and ALP was 0.740(95%CI 0.662-0.819)and 0.764(95%CI 0.688-0.840),respectively,and the differences were statistically significant(P<0.05).Conclusion Preoperative PTH and preoperative ALP are independent risk factors for postoperative hypocalcemia,and preoperative serum calcium is an independent protective factor for postoperative hypocalcemia.

关 键 词：甲状旁腺功能亢进 继发性 甲状旁腺全切 自体移植术 低钙血症 

分 类 号：R582[医药卫生—内分泌]