继发性甲状旁腺功能亢进患者术后严重低钙血症的危险因素

Risk factors for post parathyroidectomy hypocalcemia in patients with secondary hyperparathyroidism

目的:探讨继发性甲状旁腺功能亢进患者术后严重低钙血症危险因素,为临床早期干预提供理论依据.方法:本回顾性病例对照研究纳入仁济医院2017年1月至2018年12月重症医学科收治的75名继发性甲状旁腺功能亢进术后患者,并将其分为严重低钙血症组(n=32)及非严重低钙血症组(n=43).比较两组20项基线水平,经多元logistic回归分析严重低钙血症的危险因素,并通过受试者工作曲线分析各因素对于严重低钙血症的预测价值.结果:多元logistic回归提示术前碱性磷酸酶水平(OR=1.004;95%CI 1.001~1.007),术前甲状旁腺激素水平(OR=1.001;95%CI 1.000~1.002)是继发性甲状旁腺功能亢进患者术后严重低钙血症危险因素(P<0.05).经受试者工作曲线分析提示两项指标曲线下面积分别为0.865及0.850(P<0.0001),且与术前及术后血清钙离子浓度降低水平具有相关性(R2=0.3322及0.2782,P<0.0001).结论:继发性甲状旁腺功能亢进患者术前碱性磷酸酶及甲状旁腺激素水平是术后发生严重低钙血症的独立危险因素,可以指导临床早期干预.

Objective:To investigate the risk factors associated with severe hypocalcemia among secondary hyperparathyroidism (SHPT) patients underwent parathyroidectomy (PTX). Methods:A total of 75 patients with SHPT from Renji hospital were enrolled in this retrospective case-control study. Patients were assigned to a severe hypocalcemia group (n=32) and a non-severe hypocalcemia group (n=43) according to the concentration of calcium. Twenty variables from the baseline were compared and multiple logistic regression analysis was performed to identify the risk factors. Results:The concentration of preoperative alkaline phosphatase (ALP)(OR=1.004, 95%CI 1.001–1.007) and preoperative intact parathyroid hormone (iPTH)(OR=1.001, 95%CI 1.000–1.002) were revealed as risk factors (P<0.05, respectively). The receiver operator characteristics (ROC) analysis indicated that the area under curve (AUC) of ALP and iPTH in predicting the incidence of severe hypocalcemia were 0.865 and 0.850 (P<0.0001, respectively). Both of the two factors had a well relationship with the decreased concentration of calcium (P<0.0001, respectively). Conclusion:Preoperative ALP and iPTH were risk factors associated with severe hypocalcemia among SHPT patients underwent PTX and more attention should be paid on these two measures.