原发性甲状旁腺功能亢进术后低钙血症相关因素分析

Risk factors of hypocalcemia after parathyroidectomy for primary hyperparathyroidism

目的探讨原发性甲状旁腺功能亢进术后出现低钙血症及其症状的相关因素。方法收集2009年1月至2015年3月北京协和医院行手术治疗的原发性甲状旁腺功能亢进病人临床资料,分析与术后低钙血症及其症状相关的临床因素。结果 641例原发性甲状旁腺功能亢进病人成功接受甲状旁腺切除术治疗,并得到术后病理学诊断及长期随访证实。118例(18.4%)术后第一日血清总钙低于正常值下限,210例(32.8%)出现低钙血症相关的临床症状。多因素相关分析发现:原发性甲状旁腺病人术后出现低钙血症相关症状,与病人年龄、术前血清无机磷及碱性磷酸酶(ALP)相关;术后第一日血清总钙水平低于正常与术前血清全片段甲状旁腺激素(i PTH)水平相关。结论青年病人、术前血清i PTH和ALP水平增高、血清无机磷水平低可能是原发性甲状旁腺功能亢进术后低钙的相关因素。

Objective Hypocalcemia is a common condition after parathyroidectomy in the patients with primary hyperparathyroidism. The risk factors of post-operative hypocalcemia was sought to identify in this study. Methods A database about parathyroid lesions in Peking Union Medical College Hospital was searched for the patients with primary hyperparathyroidism who underwent successful parathyroidectomy between January 2009 and March 2015. Patients with malignant or familial parathyroid lesions were excluded. The possible risk factors were investigated including gender, age, preoperative calcium, phosphate, intact parathyroid hormone （iPTH） and alkaline phosphatase （ALP） levels. Results Of the 641 patients included in this study, 118 （18.4%） and 210 （32.8%） patients were diagnosed with postoperative hypocalcemia with biochemical criteria and symptomatic criteria, respectively. By applying multivariate stepwise logistic regression analysis, age, pre-operative serum phosphate and ALP level had predictive value for development of early hypocalcemia with symptomatic criteria. And the pre-operative serum iPTH level was the risk factors for the hyopcalcemia with biochemical criteria. Conclusions The age, pre-operative serum phosphate, ALP and iPTH levels were related with postoperative hypocalcemia. Patients with one or more of these factors should be monitored for possible complications with hypocalcemia.