继发性甲状旁腺切除术后高钾血症的危险因素分析

Risk factors for hyperkalemia in secondary hyperparathyroidism after parathyroidectomy

目的研究继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)患者甲状旁腺切除术(parathyroidectomy,PTX)后高钾血症的危险因素,为减少术后高钾血症提供理论依据。方法回顾性分析2014年1月~2019年10月期间常州市第一人民医院因SHPT行PTX手术患者的临床资料,按照术后血钾水平分为高钾组及非高钾组,比较2组患者PTX围手术期血钾、钙、磷、全段甲状旁腺激素(intact parathyroid hormone,iPTH)等指标差异。结果PTX患者术后血钾高于术前(t=-9.125,P<0.001),血钙、磷及iPTH低于术前(t/Z值分别为9.853,2.044,6.334;P值分别为<0.001,0.046,<0.001);有28/53(52.8%)的患者术后发生高钾血症,术前K+水平是SHPT患者PTX术后出现高钾血症的独立危险因素(β=-3.054,P=0.008)。根据ROC曲线分析,术前K+的最佳截定值为4.30mmol/L。结论术前K+水平较高的SHPT患者PTX术后出现高钾血症风险较高,积极降低术前K+水平在4.30mmol/L以下有助于减少术后高钾血症风险。

Objective Parathyroidectomy(PTX)is the main method to treat secondary hyperparathyroidism(SHPT).However,the risk factors for postoperative hyperkalemia are uncertain.This study was to investigate the risk factors for postoperative hyperkalemia after PTX for SHPT.Methods A total of 53 patients with SHPT undergoing PTX in Changzhou First People’s Hospital from January 2013 to August 2019 were involved in this study.Laboratory examinations including serum K+,Ca2+,alkaline phosphatase,phosphorus and intact parathyroid hormone were conducted before and after PTX.Results In PTX patients,postoperative serum K+was higher than preoperative level(t=-9.125,P<0.001),and postoperative serum Ca2+(t=-9.853,P<0.001),phosphorus(t=2.044,P=0.046)and iPTH(Z=-6.334,P<0.001)were lower than the preoperative levels.Postoperative hyperkalemia developed in 28(52.8%)patients.Preoperative serum K+level was the independent risk factor for hyperkalemia after PTX in SHPT patients(β=-3.054,P=0.008).The ROC curve showed that the optimal cut-off value for preoperative serum K+was 4.3mmol/L.Conclusion SHPT patients with higher serum K+before surgery have a higher risk of hyperkalemia after PTX,Lowering serum K+below 4.3mmol/L before surgery is useful to reduce the risk of postoperative hyperkalemia.