甲状腺全切除术后甲状旁腺功能减退的相关危险因素分析

Risk factors for hypoparathyroidism after total thyroidectomy

目的探讨双侧甲状腺全切除术后甲状旁腺功能减退的相关危险因素。方法回顾性分析上海交通大学医学院附属瑞金医院普外科2012年9月至2015年10月收治的200例行甲状腺全切除手术患者的临床资料，分析术后甲状旁腺功能减退的相关危险因素。影响术后甲状旁腺功能减退的单因素差异比较采用矿检验或Fisher确切概率法，采用Logistic模型进行多因素分析。利用受试者工作特征曲线（ROC曲线）下面积（AUC），评估术后第1天PTH水平及其下降比例预测术后6个月甲状旁腺功能减退的准确性。结果200例患者中术后第1天、6个月、1年甲状旁腺功能减退的比例分别为66．5％、6．5％和3．5％。其中女性（OR=2．966，95％CI：1．480～5．945，P=0．002）、年龄（OR=0．972，95％CI：0．946～0．999，P=0．039）、双侧Ⅵ区淋巴结清扫（OR=5．508，95％C1：1．693—17．923，P=0．005）是术后甲状旁腺功能减退的独立危险因素；术后第1天PTH水平（OR=0．738，95％CI：0．556—0．979，P=0．035）及术后”。I治疗（OR=12．887，95％CI：3．434～48．367，P=0．000）是影响术后6个月甲状旁腺功能减退的独立危险因素，131I治疗（OR：5．636，95％CI：1．121～28．339，P=0．036）同样是术后1年甲状旁腺功能减退的独立危险因素。术后第1天PTH〈3．05pg／ml和下降比例〉92．5％均可预测术后6个月甲状旁腺功能减退的发生，其AUC分别为82．1％和78．2％。结论双侧Ⅵ区淋巴结清扫及术后131I治疗是甲状腺全切除术后甲状旁腺功能减退的重要影响因素，术后第1天PTH水平及其下降比例可预测术后6个月甲状旁腺功能减退的发生。

Objective To evaluate the risk factors for postoperative hypoparathyroidism. Methods Tolally 200 patients with thyroid diseases undergoing total thyroideetomy at Department of General Surgery, Ruijin Hospital from Sep 2012 to Oct 2015 were followed up. The related risk factors were analyzed. X2 test and Fisher＇ s exact test were used to analyze the correlation between hypoparathyroidism after total thyroideetomy and the other clinical factors. Multiple logistic regression analysis was performed to identify these risk factors. We analyzed the receiver operating characteristic （ ROC ） curve and calculated the area under the curve （AUC）. The highest accuracy cutoff levels of intact parathyroid hormone （ iPTH ） level at 1 day after thyroidectomy （iPTH 1 d ） and % iPTH decline were determined from the ROC curves. Results Of the 200 patients, 66. 5% developed hypoparathyroidism on the first day, 6.5% developed hypoparathyroidism in 6 months after surgery. That was 3.5% in 1 year. The femaleness（ OR = 2. 966,95% CI： 1. 480 - 5. 945, P = 0. 002 ）, age （ OR = 0. 972,95% CI：0. 946 - 0. 999, P = 0. 039 ）, and bilateral center lymph node dissection （ OR = 5. 508, 95% CI： 1. 693 - 17. 923, P = 0. 005 ） were independently correlated with postoperative hypoparathyroidism. The parathyroid hormone concentration on postoperative day 1 （ OR = 0. 738,95% CI： 0. 556 - 0. 979, P = 0. 035 ） and 131i remnant ablation therapy （ OR = 12. 887,95% CI： 3.434 - 48. 367, P = 0. 000 ） were independent risk factors for postoperative hypoparathyroidism in 6 month. Both iPTH 〈3.05 pg/ml and 〉92. 5% iPTH decline on post-op dl could accurately predict significant hypoparathyroidism postoperative 6 month with accuracy of 82. 1% and 78.2%. Conclusions Bilateral center lymph node dissection and 131I remnant ablation therapy are risk factors for postoperative hypoparathyroidism, the iPTH1 d and % iPTH decline can predict hypoparathyroidism in postoperative 6 month.