原发性甲状旁腺功能亢进症致高钙血症静脉注射双膦酸盐治疗后低钙血症相关因素分析  

Risk factors of intravenous⁃bisphosphonates therapy induced hypocalcemia in patients with hypercalcemia caused by primary hyperparathyroidism

作　　者：董文静 颜世举 胡佳 赵健[1,2] 程愈 谷伟军[2] Dong Wenjing;Yan Shiju;Hu Jia;Zhao Jian;Cheng Yu;Gu Weijun(Chinese PLA Medical College,Beijing 100039,China;不详)

机构地区：[1]解放军医学院,北京100039 [2]解放军总医院第一医学中心内分泌科 [3]解放军总医院海南医院骨科

出　　处：《临床内科杂志》2023年第9期613-617,共5页Journal of Clinical Internal Medicine

基　　金：海南省临床医学中心建设项目(琼卫医函[2021]276号)。

摘　　要：目的 探讨原发性甲状旁腺功能亢进症(PHPT)致高钙血症患者经静脉注射双膦酸盐治疗后出现低钙血症的相关危险因素。方法 纳入2011年~2022年解放军总医院收治的PHPT致高钙血症患者54例。根据血清钙检测结果,将所有患者分为正常血钙组(45例,血钙≥2.25 mmol/L)和低血钙组(9例,血钙<2.25 mmol/L);根据使用双膦酸盐药物的不同,再将所有患者分为唑来膦酸组(37例)、帕米膦酸二钠组(10例)和伊班膦酸组(7例)。收集所有患者的一般资料、临床表现、实验室及影像学检查结果、诊治情况并分组进行比较。采用二元logistic回归分析评估PHPT患者经静脉注射双磷酸盐治疗后出现低钙血症的危险因素;采用受试者工作特征(ROC)曲线评估相关指标对PHPT患者发生低钙血症的预测价值。结果 正常血钙组患者BMI、腰椎及股骨颈骨矿密度(BMD)均高于低血钙组,腰椎BMD T及Z值、股骨颈BMD T及Z值均低于低血钙组(P<0.05);三种静脉注射双膦酸盐药物组降钙疗效及达最低血钙天数比较差异均无统计学意义(P>0.05)。二元Logistic回归分析结果显示,PHPT患者BMI、腰椎和股骨颈BMD与静脉注射双膦酸盐治疗后出现低钙血症均呈负相关(P<0.05)。ROC曲线分析结果显示,股骨颈与腰椎BMD、BMI三者联合预测低钙血症发生的曲线下面积(AUC)为0.921,敏感度及特异度分别为100%、75.56%,显著高于单独各指标(P<0.001)。结论 BMI、股骨颈与腰椎BMD偏低的PHPT致高钙血症患者接受静脉注射双膦酸盐治疗时易出现低钙血症,上述指标联合检测对患者发生低钙血症具有较高预测价值。Objective To investigate the risk factors of hypocalcemia in primary hyperparathy⁃roidism(PHPT)patients with hypercalcemia caused by intravenous⁃bisphosphonates therapy.Methods A total of 54 PHPT patients with hypercalcemia in PLA General Hospital from 2011 to 2022 were included.All patients were divided into normal blood calcium group(45 cases,blood calcium≥2.25 mmol/L)and low blood calcium group(9 cases,blood calcium<2.25 mmol/L)according to blood calcium level.Patients were divided into Zoledronate group(37 cases),Pamidronate disodium group(10 cases)and Ibandronate group(7 cases)according to the use of bisphospbanate drings.General data,clinical manifestation,laboratory and imaqing examination results and radiologic findings and the diagnosis and treatment of patients were collected and compored in groups.Binary logistic regression analy was used to evelluate the risk factors of hypocalcemia in PHPT patients after intravenous⁃bisphosphonates therapy.Receiver operating characteristic(ROC)curve was used to evelluate the diagnostic value of related indicators for hypocalcemia in PHPT patients.Results BMI,lumbar spine and femoral neck bone mineral density(BMD)of normal blood calcium group were significantly higher than those on low blood calcium group while T score and Z score of femoral neck and lumbar spine were significantly lower than those in low blood calcium group(P<0.05).No difference was found in the calcium lowering efficacy and days to the minimum blood calcium in three bisphosphonates(P>0.05).BMD of lumbar spine and femoral neck,BMI in PHP T patents were identified to be negative related with intravenous⁃bisphosphonates therapy induced hypocalcemia through binary logistic regression analysis(P<0.05).The area under the curve(AUC)on ROC analysis of the combination of BMI,lumbar spine BMD and femoral neck BMD was 0.921,sensitivity and speciality rate were 100%,75.56%,which significantly higher than that in single index(P<0.001).Conclusion Patients with hypercalcemia caused by PHPT are more likel

关 键 词：原发性甲状旁腺功能亢进症 高钙血症 双膦酸盐 低钙血症 

分 类 号：R58[医药卫生—内分泌]