维持性血液透析患者甲状旁腺切除术后早期骨饥饿综合征风险预测模型的构建与验证  

Construction and validation of a risk prediction model for early hungry bone syndrome in maintenance hemodialysis patients post-parathyroidectomy

作　　者：王露芳[1] 李远明[1] 刘新新 侯蓓 徐勇[1] WANG Lufang;LI Yuanming;LIU Xinxin;HOU Bei;XU Yong(Department of Nephrology,Third Xiangya Hospital,Central South University,Changsha 410013;Department of Nephrology,Changsha Jieao Nephrology Hospital,Changsha 410008,China)

机构地区：[1]中南大学湘雅三医院肾内科,长沙410013 [2]长沙捷奥肾病医院肾内科,长沙410008

出　　处：《中南大学学报（医学版）》2024年第5期784-794,共11页Journal of Central South University ：Medical Science

基　　金：湖南省创新型省份建设专项(2023ZK4166)。

摘　　要：目的:甲状旁腺切除术(parathyroidectomy,PTX)是治疗难治性继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)的有效方法,但PTX后极易出现骨饥饿综合征(hungry bone syndrome,HBS),严重威胁维持性血液透析(maintenance hemodialysis,MHD)患者的生命健康。目前已有研究分析PTX后并发HBS的风险因素,但风险预测模型的预测性能和临床适用性仍待进一步验证。本研究旨在构建MHD伴SHPT患者PTX后并发HBS的风险预测模型,并验证其预测效果。方法:回顾性收集2020年1月至2021年12月在长沙捷奥肾病医院行PTX的MHD伴SHPT的368例患者为训练集,按照是否发生HBS分为HBS组和non-HBS组,对2组的一般资料、手术相关信息、生化指标等进行比较,应用多因素logistic回归筛选HBS的影响因素,建立风险预测模型。采用受试者操作特征(receiver operator characteristic,ROC)曲线、决策曲线、校准曲线对模型进行评价。收集2022年1至12月在中南大学湘雅三医院行PTX的MHD伴SHPT的170例患者为验证集进行外部验证。结果:MHD伴SHPT患者PTX后HBS发生率为60.60%,logistic回归分析结果显示:术前骨骼受累(OR=3.908,95%CI 2.179~7.171)、术前血钙(OR=7.174,95%CI 2.291~24.015)、术前全段甲状旁腺激素(intact parathyroid hormone,i PTH)(OR=1.001,95%CI 1.001~1.001)、术前碱性磷酸酶(alkaline phosphatase,ALP)(OR=1.001,95%CI 1.000~1.001)、术后第1天血钙(OR=0.006,95%CI0.001~0.038)是MHD患者伴SHPT行PTX后并发HBS的独立危险因素(均P<0.01)。构建的风险预测模型在内部训练集和外部验证集中均表现出良好的预测结果,内部验证集的准确度为0.821,灵敏度为0.890,特异度为0.776,约登指数为0.666,曲线下面积(area under curve,AUC)为0.882(95%CI 0.845~0.919);外部验证集的准确度为0.800,灵敏度为0.806,特异度为0.799,约登指数为0.605,AUC为0.863(95%CI 0.795~0.932)。结论:术前骨骼受累、术前血钙、术前iPTH、术前ALP、术后第1天血钙Objective:Parathyroidectomy(PTX)is an effective treatment for refractory secondary hyperparathyroidism(SHPT),but it can lead to hungry bone syndrome(HBS),significantly threatening the health of maintenance haemodialysis(MHD)patients.While previous studies have analyzed the risk factors for HBS post-PTX,the predictive performance and clinical applicability of these risk models need further validation.This study aims to construct and validate a risk prediction model for HBS in MHD patients with SHPT post-PTX.Methods:A retrospective analysis was conducted on 368 MHD patients with SHPT who underwent PTX at Changsha Jieao Nephrology Hospital from January 2020 to December 2021.Patients were divided into a HBS group and a non-HBS group based on the occurrence of HBS.General data,surgical information,and biochemical indicators were compared between the 2 groups.Multivariate logistic regression was used to identify factors influencing HBS,and a risk prediction model was established.The model’s performance was evaluated using receiver operator characteristic(ROC)curves,decision curves,and calibration curves.External validation was performed on 170 MHD patients with SHPT who underwent PTX at the Third Xiangya Hospital of Central South University from January to December 2022.Results:The incidence of HBS post-PTX in MHD patients with SHPT was 60.60%.Logistic regression analysis identified preoperative bone involvement(OR=3.908,95%CI 2.179 to 7.171),preoperative serum calcium(OR=7.174,95%CI 2.291 to 24.015),preoperative intact parathyroid hormone(iPTH)(OR=1.001,95%CI 1.001 to 1.001),preoperative alkaline phosphatase(ALP)(OR=1.001,95%CI 1.000 to 1.001),and serum calcium on the first postoperative day(OR=0.006,95%CI 0.001 to 0.038)as independent risk factors for HBS(all P<0.01).The constructed risk prediction model demonstrated good predictive performance in both internal and external validation cohorts.The internal validation cohort showed an accuracy of 0.821,sensitivity of 0.890,specificity of 0.776,Youden index of 0.666,a

关 键 词：维持性血液透析 继发性甲状旁腺功能亢进症 甲状旁腺切除术 骨饥饿综合征 风险预测模型 

分 类 号：R692.5[医药卫生—泌尿科学] R653[医药卫生—外科学]