术中甲状旁腺激素测定对继发性甲状旁腺功能亢进患者手术疗效的预测价值

Predictive value of intraoperative parathyroid hormone measurement in patients with secondary hyperparathyroidism

目的:观察术中甲状旁腺激素(intraoperative parathyroidhormone,IOPTH)测定对透析患者继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)行甲状旁腺切除手术(parathyroidectomy,PTx)成功的预测价值。方法:收集2017-07-01~2019-03-31期间151例行PTx的SHPT透析患者,测定术中最后一个甲状旁腺切除后20 min PTH值(PTH20),30 min PTH值(PTH30),计算PTH20、PTH30与术前PTH下降率(PTH20%,PTH30%)。患者术后1周甲状旁腺激素水平PTH<100 pg/ml判断为手术成功。分析不同的PTH20值、PTH30值及PTH20%,PTH30%对手术成功的预测价值。结果:PTH20<207.5 pg/ml、PTH30<106.5 pg/ml、PTH20%>91.38%、PTH30%>95.78%是在术中判断手术成功的较佳标准,PTH20<207.5 pg/ml时预测手术成功的敏感度为85.9%,特异度为73.9%;PTH30<106.5 pg/ml预测手术成功的敏感度为89.1%,特异度为65.2%;PTH20%>91.38%预测手术成功的敏感度为75.8%,特异度为78.3%;PTH30%>95.78%预测手术成功的敏感度为75%,特异度为69.6%。结论:PTH20和PTH30水平可用于预测PTx手术成功与否,IOPTH测定有助于减少不必要的扩大范围的手术探查和相应并发症。

Objective:To observe the predictive value of intraoperative parathyroid hormone(IOPTH)determination on the success of parathyroidectomy(PTx)for secondary hyperparathyroidism(SHPT)in dialysis patients.Methodology:A total of 151 dialysis patients with SHPT who underwent parathyroidectomy from July 1,2017 to March 31,2019 were collected,and the PTH values of 20 min(PTH20)and 30 min(PTH30)after the last parathyroid gland was removed during operation were measured,PTH20,PTH30 and preoperative PTH decline rate(PTH20%,PTH30%)were calculated.PTH<100 pg/ml a week after surgery was judged as successful operation.The predictive value of PTH20,PTH30,PTH20%and PTH30%to judge successful of operation were analyzed.Results:PTH20<207.5 pg/ml,PTH30<106.5 pg/ml,PTH20%>91.38%,PTH30%>95.78%are the best criteria for judging the success of operation.When PTH20<207.5 pg/ml,sensitivity to predict successful operation is 85.9%,and specificity is 73.9%;And the sensitivity of PTH30<106.5 pg/ml to predict successful operation was 89.1%,and the specificity was 65.2%;PTH20%>91.38%predicted the success of surgery with a sensitivity of 75.8%and a specificity of 78.3%,PTH30%>95.78%predicted the success of surgery with a sensitivity of 75%and a specificity of 69.6%.Conclusion:IOPTH is a useful method to predict the complete surgical removal of parathyroid glands.Intraoperative determination of parathyroid hormone PTH20,PTH30 can be basically predicted the successful operation.