基于贝叶斯网络模型分析甲状腺乳头状癌患者术后低钙血症发生的相关因素

Analysis of the risk factors of postoperative hypocalcemia in patients with papillary thyroid carcinoma based on Bayesian network model

目的基于贝叶斯(Bayesian)网络模型分析甲状腺乳头状癌(PTC)患者术后发生低钙血症(PHC)的影响因素。方法选取2019年1月—2020年4月武汉大学中南医院接受手术治疗的PTC患者200例作为研究对象,根据术后第48 h患者血钙(Ca)水平判断是否发生PHC,将患者纳入发生组与未发生组。比较2组患者基线资料及相关实验室指标[Ca、磷(P)、镁(Mg)、白蛋白(Alb)、25-羟基维生素D[25(OH)D]、游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))、促甲状腺激素(TSH)、甲状旁腺素(PTH)、降钙素(CT)],采用Logistic回归分析和贝叶斯网络模型分析PTC患者术后发生PHC的影响因素,ROC曲线分析其诊断PTC患者术后发生PHC的效能。结果200例PTC患者术后发生低钙血症62例(31.00%),未发生低钙血症138例(69.00%);发生组女性患者、双侧淋巴结清扫占比高于未发生组(χ^(2)/P=4.333/0.037,7.366/0.007);发生组血清Ca、P、Mg、Alb、25(OH)D、PTH水平均低于未发生组,血清CT水平高于未发生组(t/P=4.534/<0.001、3.301/0.001、3.217/0.002、11.957/<0.001、7.728/<0.001、8.756/<0.001、4.093/<0.001);2组血清FT_(4)、FT_(3)、TSH水平比较,差异无统计学意义(P>0.05)。经Logistic回归分析,双侧淋巴结清扫、血清CT过表达是PTC术后发生PHC的危险因素[OR(95%CI)=125.841(1.248~12684.321)、1.352(1.055~1.732)];血清Ca、Mg、Alb、25(OH)D、PTH过表达是PTC术后发生低钙血症的保护因素[OR(95%CI)=0.000(0~0.040)、0.000(0~0.023)、0.136(0.035~0.539)、0.229(0.071~0.735)、0.221(0.067~0.727)]。ROC曲线结果显示,血清Ca、Mg、Alb、25(OH)D、PTH、CT诊断PTC患者术后发生PHC的曲线下面积(AUC)分别为0.694、0.634、0.799、0.828、0.912、0.684。经贝叶斯网络模型分析显示,血清25(OH)D、Mg、Ca、PTH、Alb与PHC直接相关,双侧淋巴结清扫、血清CT与PHC间接相关。结论双侧淋巴结清扫、血清CT过表达是PTC术后发生低钙血症的危险因素,与PHC间接相关;血清Ca、Mg、Alb、25(OH)D、PTH过表达是其保护因素,与PHC直接相关。

Objective To analyze the influencing factors of postoperative hypocalcemia(PHC)in patients with papillary thyroid carcinoma(PTC)based on Bayesian network model.Methods Selected 200 PTC patients who received surgical treatment in Zhongnan Hospital of Wuhan University from January 2019 to April 2020 as the research objects.According to the serum calcium(Ca)level of the patients at the 48th hour after surgery,the patients were included in the incidence group and the incidence group according to whether PHC occurred or not.No group occurred.The baseline data and related laboratory indicators[Ca,phosphorus(P),magnesium(Mg),albumin(Alb),25-hydroxy(OH)vitamin D,free triiodothyronine(FT_(3)),free triiodothyronine(FT_(3)),free Thyroxine(FT_(4)),thyroid stimulating hormone(TSH),parathyroid hormone(PTH),calcitonin(CT)].Logistic regression analysis and Bayesian network model were used to analyze the influencing factors of postoperative PHC in PTC patients,and the ROC curve was used to analyze its efficacy in diagnosing postoperative PHC in PTC patients.Results Of the 200 PTC patients,62(31.00%)had hypocalcemia after surgery,and 138(69.00%)had no hypocalcemia.The proportion of female patients and bilateral lymph node dissection in the incidence group was higher than that in the non-occurrence group(χ^(2)/P=4.333/0.037,7.366/0.007).Serum levels of Ca,P,Mg,Alb,25(OH)D,and PTH in the occurrence group were lower than those in the non-occurrence group,and serum CT levels were higher than those in the non-occurrence group(t/P=4.534/<0.001,3.301/0.001,3.217/0.002,11.957/<0.001,7.728/<0.001,8.756/<0.001,4.093/<0.001).There was no significant difference in serum FT_(4),FT_(3) and TSH levels between the two groups(P>0.05).Logistic regression analysis showed that bilateral lymph node dissection and serum CT overexpression were risk factors for PHC after PTC[OR(95%CI)=125.841(1.248-12684.321),1.352(1.055-1.732)].Serum Ca,Mg,Alb,25(OH)D and PTH overexpression are protective factors for hypocalcemia after PTC[OR(95%CI)=0.000(0-0.040),0.000(0-0.023)),0.136(0.035-0.539),0.229(0.071-0.735),0.221(0.067-0.727)].The results of the ROC curve showed that the areas under the curve(AUC)of serum Ca,Mg,Alb,25(OH)D,PTH,and CT for postoperative PHC in patients with PTC were 0.694,0.634,0.799,0.828,0.912,and 0.684,respectively.The Bayesian network model analysis showed that serum 25(OH)D,Mg,Ca,PTH,and Alb were directly related to PHC,and bilateral lymph node dissection and serum CT were indirectly related to PHC.Conclusion Bilateral lymph node dissection and serum CT overexpression are risk factors for hypocalcemia after PTC,and are indirectly related to PHC.The overexpression of serum Ca,Mg,Alb,25(OH)D and PTH were its protective factors,which were directly related to PHC.