分化型甲状腺癌术后血镁变化与低钙血症的临床关系分析

Role of magnesium in post-thyroidectomy hypocalcemia with differentiated thyroid carcinoma

目的探讨分化型甲状腺癌术后血镁浓度变化在生化性低钙血症和症状性低钙血症的的关系。方法对中南大学湘雅医院同一手术组2017年11月~2018年3月行甲状腺手术的137例分化型甲状腺癌患者的临床资料进行回顾性分析,采用二分类Logistic回归和相关检验确定生化和症状性低钙血症与术后血镁的关系。结果 36例(26.28%)患者术后出现低镁血症,术后血镁浓度(0.70±0.07)mmol/L低于术前水平(0.87±0.07)mmol/L,低镁血症的发生率在低钙血症组(32.69%)较正常血钙组(22.35%)明显升高,相比术后血钙正常患者,低钙血症患者术后24小时血镁浓度较术前明显下降(P<0.05)。Logistic回归分析显示性别(女性)(HR=5.36,P=0.02)、行甲状腺癌改良根治术(HR=4.03,P=0.02)、甲状旁腺功能减退症(HR=4.63,P<0.001)是导致生化性低钙血症的独立危险因素。而症状性低钙血症仅与甲状腺癌改良根治术(HR=2.99,P=0.025)和甲状旁腺功能减退症(HR=9.90,P<0.001)有关。结论血镁浓度在甲状腺切除术后普遍降低,尤其是在低钙血症患者,但术后低镁血症并不是生化性或症状性低钙血症发生的独立危险因素。

OBJECTIVE To invest igate the relationship of serum magnesium level and biochemical and symptomatic hypocalcemia in patients with differentiated thyroid cancer. METHODS The clinical data of 137 patients with differentiated thyroid papillary carcinoma who underwent total thyroidectomy from November2017 to March 2018 in the same surgery group at Xiangya Hospital of Central South University were retrospectively analyzed. Logistic regression and correlation tests were used to determine the relationship between biochemical and symptomatic hypocalcemia and postoperative magnesium levels. RESULTS Hypomagnesemia occur red in 36 pat ients（26.28%） af t e r operat ion. Postoperat ive magnesium concentrations were lower than preoperative levels（0.70±0.07 mmol/L vs 0.87±0.07 mmol/L,P〈 0.05）. The incidence of hypomagnesemia was significantly higher in the hypocalcemic group than in the normal calcium group（32.69% vs 22.35%, P 〈0.001）.Compared with patients of normal postoperative serum calcium, serum magnesium concentrations in patients with hypocalcemia were significantly lower than those before surgery（P 〈0.05）. Logistic regression analysis showed that sex（female）（HR=5.36, P =0.02）, MRND（HR=4.03, P =0.02）, hypoparathyroidism（HR=4.63,P 〈0.001） were the independent risk factors of biochemical hypocalcemia. However, symptomatic hypocalcemia was only associated with MRND（HR=2.99, P =0.025） and hypoparathyroidism（HR=9.90, P 〈0.001）. CONCLUSION The serum magnesium concentration was generally decreased after thyroidectomy, especially in patients with hypocalcemia. However, postoperative hypomagnesemia is not an independent risk factor for biochemical or symptomatic hypocalcemia.