血钙及血清甲状旁腺激素水平对腔镜甲状腺切除术患者发生PHPP的预测作用

Predictive value of serum calcium and parathyroid hormone levels for phpp in patients undergoing endoscopic thyroidectomy

目的分析血钙与血清甲状旁腺激素(iPTH)在腔镜甲状腺切除术患者中的变化及对发生永久性甲状旁腺功能减退症(PHPP)的预测作用。方法选取2010年6月-2020年6月在华北石油总医院二部医院实施腔镜甲状腺切除术的患者489例,均在术前及术后24h抽血检测血钙及血清PTH水平。术后随访6个月,统计PHPP发生率,比较发生PHPP患者与未发生PHPP患者的血钙与血清iPTH水平。以受试者工作特征曲线(ROC)及曲线下面积(AUC)分析血钙与血清iPTH对发生PHPP的预测作用。结果489例患者均手术顺利,术后180例(36.81%)有低钙血症,189例(38.65%)血清iPTH下降。PHPP患者的血钙与血清iPTH水平均低于未发生PHPP患者,差异有统计学意义(P<0.05)。ROC曲线分析,术后24h分别以1.80mmol/L、10.64pg/mL为临界点,预测发生PHTT的灵敏度分别为66.67%、72.00%,特异度分别为83.01%、81.40%,AUC分别为0.751(95%CI:0.710-0.789)、0.803(0.716-0.794),约登指数分别为0.461、0.542,血钙与血清iPTH联合预测的灵敏度、特异度、AUC、约登指数分别为64.71%、96.61%、0.834(95%CI:0.798-0.866)、0.613,联合预测的特异度、AUC、约登指数更高。结论腔镜甲状腺切除术患者术后24h血钙与血清iPTH水平对于预测PHPP的发生有较高的价值,可作为PHPP的预测指标指导临床治疗。

Objective To analyze the changes of serum calcium and serum intact parathyroid hormone(iPTH)in patients undergoing laparoscopic thyroidectomy and their predictive effect on the occurrence of permanent hypoparathyroidism(PHPP).Methods A total of 489patients who underwent endoscopic thyroidectomy in the second hospital of huabei petroleum administration bureau general hospital from June 2010to June 2020were selected.Blood samples were taken before and 24hours after the operation for blood calcium and serum PTH levels.Follow-up for 6months after the operation,the incidence of PHPP was calculated,and the blood calcium and serum iPTH levels of patients with PHPP and those without PHPP were compared.The receiver operating characteristic curve(ROC)and area under the curve(AUC)were used to analyze the predictive effects of blood calcium and serum iPTH on the occurrence of PHPP.Results All 489patients were operated successfully,180patients(36.81%)had hypocalcemia after operation,and 189patients(38.65%)had a decrease in serum iPTH.The levels of serum calcium and iPTH in patients with PHPP were lower than those in patients without PHPP(P<0.05).ROC curve analysis showed that the sensitivity,specificity,AUC and Youden index of predicting PHPP were 66.67%,72.00%,83.01%,81.40%,0.751(95%CI:0.710-0.789),0.803(0.716-0.794)and 0.461,0.542,respectively.The sensitivity,specificity,AUC and Youden index of combined prediction of serum calcium and serum iPTH were 64.71%,96.61%,0.834(95%CI:0.798-0.866)and 0.613,respectively.The specificity,AUC and Youden index of combined prediction were higher.Conclusion The levels of blood calcium and serum iPTH in patients undergoing endoscopic thyroidectomy at 24hours after surgery have a high value in predicting the occurrence of PHPP,and can be used as predictive indicators of PHPP to guide clinical treatment.