血清校正钙及iPTH对甲状腺全切术后发生甲状旁腺功能减退的预测价值

Predictive value of serum corrected calcium and iPTH levels for hypoparathyroidism after total thyroidectomy

目的探讨血清校正钙及全段甲状旁腺激素(iPTH)对甲状腺全切术后发生甲状旁腺功能减退的预测价值。方法采用前瞻性研究,选择2017年6月至2019年6月在池州市人民医院行甲状腺全切术+中央区淋巴结清扫的86例甲状腺乳头状癌患者为观察对象,分析患者术后的甲状旁腺功能减退发生情况及其危险因素;依据术后甲状旁腺功能减退发生情况将患者分为甲状旁腺功能减退组和无甲状旁腺功能减退组,比较两组患者在术前,术后1、3 d及随访期间(术后6个月)血清校正钙及iPTH水平。采用受试者工作特征(ROC)曲线评估患者术后1 d血清校正钙及iPTH水平对甲状腺全切术后发生甲状旁腺功能减退的预测价值。结果在纳入的86例甲状腺乳头状癌患者中,男性17例、女性69例,年龄为(46.3±5.6)岁;术后发生甲状旁腺功能减退者42例,发生率为48.84%;其中,有不同程度的低血钙症状者32例(37.21%),出现永久性甲状旁腺功能减退者2例(2.33%)。logistic回归分析结果显示,腺外侵犯[比值比(OR)=19.28,95%置信区间(CI):2.63~136.81]、双侧中央区淋巴结清扫(OR=1.84,95%CI:1.36~9.13)为甲状腺全切术后发生甲状旁腺功能减退危险因素。在术前、术后6个月,甲状旁腺功能减退组和无甲状旁腺功能减退组患者血清校正钙、iPTH水平比较,差异均无统计学意义(P均>0.05);术后1、3 d,甲状旁腺功能减退组患者血清校正钙及iPTH水平均显著低于无甲状旁腺功能减退组(P均<0.01)。ROC曲线结果显示,血清校正钙的曲线下面积(AUC)=0.724,灵敏度和特异度分别为76.68%、62.14%;iPTH的AUC=0.947,灵敏度和特异度分别为97.68%、92.14%。结论腺外侵犯、双侧中央区淋巴结清扫为甲状腺全切术后发生甲状旁腺功能减退的危险因素,iPTH水平是甲状旁腺功能减退可靠的预测指标。

Objective To explore the predictive value of serum corrected calcium and intact parathyroid hormone(iPTH)for hypoparathyroidism after total thyroidectomy.Methods A prospective study was used to select 86 patients with papillary thyroid carcinoma who underwent total thyroidectomy and central lymph node dissection in Chizhou people's Hospital from June 2017 to June 2019 as the observation objects,and the occurrence of postoperative hypoparathyroidism and its risk factors were analyzed.According to the occurrence of postoperative hypoparathyroidism,the patients were divided into hypoparathyroidism group and non-hypoparathyroidism group,the levels of serum corrected calcium and iPTH of patients in two groups were compared before operation,1,3 days after operation,and during follow-up(6 months after operation).Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum corrected calcium and iPTH levels in patients with hypoparathyroidism after total thyroidectomy on the first day after surgery.Results Among 86 patients with papillary thyroid carcinoma,17 were males and 69 were females,aged(46.3±5.6)years old;42 patients had postoperative hypoparathyroidism(48.84%);among them,32 cases(37.21%)had hypocalcemia in different degrees,and 2 cases(2.33%)had permanent hypoparathyroidism.Logistic analysis showed that extraglandular invasion[odds ratio(OR)=19.28,95%confidence interval(CI):2.63-136.81],bilateral central lymph node dissection(OR=1.84,96%CI:1.36-9.13)were risk factors for hypoparathyroidism after total thyroidectomy.There were no significant differences in serum corrected calcium and iPTH levels between hypoparathyroidism group and non-hypoparathyroidism group before and 6 months after operation(P>0.05);the serum corrected calcium and iPTH levels in the hypoparathyroidism group were significantly lower than those in non-hypoparathyroidism group 1 and 3 days after operation(P<0.01).The ROC curve results showed that the area under the curve(AUC)of serum corrected calcium was 0.724,the sensitivity and specificity were 76.68%and 62.14%,respectively;the AUC of iPTH was 0.947,the sensitivity and specificity were 97.68%and 92.14%,respectively.Conclusion Extraglandular invasion and bilateral central lymph node dissection are risk factors for hypoparathyroidism after total thyroidectomy,and the iPTH level is a more reliable predictor of hypoparathyroidism.