继发性甲状旁腺功能亢进症术后低钙血症相关因素分析

Analysis of risk factors of hypocalcemia in patients with secondary hyperparathyroidism after operation

目的探讨继发性甲状旁腺功能亢进症(SHPT)患者术后发生低钙血症的相关因素。方法回顾性分析62例接受了双侧甲状旁腺全切除术+前臂甲状旁腺自体移植术的SHPT患者的临床资料,包括性别、年龄、透析类型、透析时间、体质量、术前术后生化指标等。采用多因素Logistic回归分析模型分析术后发生低钙血症的独立危险因素。结果所有患者术中切除甲状旁腺后15 min甲状旁腺激素(PTH)水平均下降80%以上,术后24 h PTH水平降至20~30 pg/ml;血钙水平于术后24 h明显下降,48 h降至低值。多因素Logistic回归分析结果显示透析方式(OR=0.173,P=0.038)、术前PTH水平(OR=1.003,P<0.001)、术前肌酐水平(OR=1.004,P=0.001)是术后低钙血症的独立影响因素。结论腹透透析方式、术前PTH水平偏高、术前肌酐水平偏低是甲状旁腺全切除术+前臂甲状旁腺自体移植术后出现低钙血症的独立危险因素。

Objective To identify the risk factors of hypocalcemia in patients with secondary hyperparathyroidism(SHPT)after operation.Methods Clinical data of 62 SHPT patients who underwent bilateral total parathyroidectomy combined with forearm autotransplantation were retrospectively analyzed.Gender,age,dialysis mode,dialysis time,weight,preoperative and postoperative biochemical indexes were collected.The independent risk factors of postoperative hypocalcemia were identified by multivariate Logistic regression analysis.Results The parathyroid hormone(PTH)level was decreased by more than 80%at 15 min after parathyroidectomy in all patients,and declined to 20-30 pg/ml at postoperative 24 h.The blood calcium level was significantly decreased at 24 h after surgery and declined to the lowest level at postoperative 48 h.Multivariate Logistic regression analysis showed that dialysis mode(OR=0.173,P=0.038),preoperative PTH level(OR=1.003,P<0.001),preoperative creatinine level(OR=1.004,P=0.001)were the independent risk factors of postoperative hypocalcemia.Conclusions Peritoneal dialysis mode,preoperative PTH level,preoperative creatinine level are the independent risk factors of postoperative hypocalcemia following total parathyroidectomy combined with forearm autotransplantation.