分化型甲状腺癌术后甲状旁腺功能减退风险综合预测模型建立

Establishment of a comprehensive prediction model for hypoparathyroidism after radical operation of differentiated thyroid carcinoma

目的探讨分化型甲状腺癌术后甲状旁腺功能减退的影响因素,建立分化型甲状腺癌术后甲状旁腺功能减退风险综合预测模型。方法回顾性分析2018年9月至2019年12月蚌埠医学院第一附属医院肿瘤外科收治的100例分化型甲状腺癌病人的临床资料。(1)根据术后4 h外周静脉血甲状旁腺激素值分为减退组(23例)与正常组(77例)。对两组指标进行多因素Logistic回归分析,用其中差异有统计学意义的指标构建分化型甲状腺癌术后甲状旁腺功能减退风险综合预测模型,并评估此模型的性能。(2)根据术后6个月外周静脉血甲状旁腺激素值将术后甲状旁腺功能减退病人分为暂时性减退组(17例)和永久性减退组(6例),对两组指标进行比较分析。结果多因素分析表明,淋巴结清扫方式、原位保留甲状旁腺情况及淋巴结转移情况是术后甲状旁腺功能减退的独立影响因素。术后甲状旁腺功能减退的预测模型为:P=Exp(2.271-2.274X_(1)-1.934X_(2)-1.425X_(3))/[1+Exp(2.271-2.274X_(1)-1.934X_(2)-1.425X_(3))],其中X_(1)=淋巴结清扫方式,X_(2)=原位保留甲状旁腺情况,X_(3)=淋巴结转移情况。曲线下面积为86.3%,截点值为0.312,敏感度为80.1%,特异度为85.3%。永久性甲状旁腺功能减退的发生与有效原位保留甲状旁腺情况密切相关。结论分化型甲状腺癌术后甲状旁腺功能减退综合预测模型对术后甲状旁腺功能减退风险具有较好的预测能力。

Objective To explore the influencing factors of hypoparathyroidism and establish a comprehensive prediction model for hypoparathyroidism after surgery of differentiated thyroid carcinoma.Methods The clinical and pathological data of 100 patients with differentiated thyroid carcinoma admitted from September 2018 to December 2019 in Department of Oncology Surgery,the First Affiliated Hospital of Bengbu Medical College were analyzed retrospectively,and the patients were divided into hypoparathyroidism group(n=23)and non-hypoparathyroidism group(n=77)according to PTH in the peripheral blood at 4 hours after surgery.Parameters were included in multivariate logistic regression analysis.The comprehensive prediction model for hypoparathyroidism after surgery of differentiated thyroid carcinoma was constructed by multivariate analysis with statistically significant indexes,and the receiver operating characteristic curve curve was applied to evaluate the performance of the model.The patients with hypoparathyroidism were divided into temporary hypoparathyroidism group(n=17)and permanent hypoparathyroidism group(n=6)according to PTH in the peripheral blood at 6 months after surgery.Univariate analysis was carried out for the parameters of two groups.Results Multivariate analysis showed that the type of lymph node dissection,preservation of parathyroid glands in situ and lymphatic metastasis were independent predictors of hypoparathyroidism after radical operation of differentiated thyroid carcinoma.Comprehensive prediction model for hypoparathyroidism after radical operation of differentiated thyroid carcinoma was P=Exp(2.271-2.274X_(1)-1.934X_(2)-1.425X_(3))/[1+Exp(2.271-2.274X_(1)-1.934X_(2)-1.425X_(3))](X_(1)=type of lymph node dissection,X_(2)=preservation of parathyroid glands in situ,X_(3)=lymphatic metastasis).The area under the curve,cut-off vaule,sensitivity and specificity of the predictive model of hypoparathyroidism after radical operation of differentiated thyroid carcinoma were 86.3%,0.312,80.1% and 85.3% respectively.The occurrence of permanent hypoparathyroidism was closely related to preservation of parathyroid glands in situ.Conclusion The comprehensive prediction model for hypoparathyroidism has a good prediction ability for hypoparathyroidism after radical operation of differentiated thyroid carcinoma.