术前白蛋白水平对继发性甲状旁腺功能亢进患者术后重度低钙血症的预测价值

Value of preoperative albumin level in predicting postoperative severe hypocalcemia in patients with secondary hyperparathyroidism

目的:探讨术前白蛋白(albumin,ALB)水平对继发性甲状腺功能亢进(secondary hyperthyroidism,SHPT)患者术后重度低钙血症(severe hypocalcemia,SH)的预测价值。方法:回顾性分析2019年1月至2021年6月六安市中医院甲乳外科收治90例SHPT患者的相关资料,依据甲状旁腺切除术(parathyroidectomy,PTX)术后血钙监测情况,分为SH组(血钙水平≤1.8 mmol/L;n=29)与对照组(血钙水平>1.8 mmol/L,n=61)。比较两组围手术期相关资料,采用多因素logistic回归模型和绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析术前ALB水平与SHPT患者PTX术后SH发生的关系。结果:SH组术前碱性磷酸酶(alkaline phosphatase,ALP)、ALB水平和甲状旁腺切除个数≥4个的比重高于对照组(P<0.05)。术前ALP(OR=1.442,95%CI:1.334~5.881)、术前ALB(OR=1.391,95%CI:1.168~3.159)、甲状旁腺切除数≥4个(OR=2.248,95%CI:1.211~7.352)是PTX术后SH发生的独立危险因素(P<0.05)。术前ALB预测SHPT患者PTX术后SH发生的曲线下面积(area under curve,AUC)为0.714(95%CI:0.577~0.850),术前ALP预测的ACU为0.729(95%CI:0.586~0.872),二者比较差异无统计学意义(P>0.05)。结论:术前ALB水平是SHPT患者PTX术后SH发生的危险因素,对临床早期筛查SH高危人群和预测SH发生有参考价值。

Objective:To investigate the predictive value of preoperative albumin(ALB)level on postoperative severe hypocalcemia(SH)in patients with secondary hyperparathyroidism(SHPT).Methods:The data of 90 patients with SHPT treated in the Department of Thyroid Gland and Breast Surgery of Lu’an Hospital of Traditional Chinese Medicine from January 2019 to June 2021 were analyzed retrospectively.According to the blood calcium monitoring after parathyroidectomy(PTX),they were divided into an SH group(blood calcium level≤1.8 mmol/L,n=29)and a control group(blood calcium level>1.8 mmol/L,n=61).The perioperative related data of the 2 groups were compared.The relationship between preoperative ALB level and the occurrence of SH after PTX in SHPT patients was analyzed by multivariate logistic regression model and receiver operating characteristic curve.Results:The levels of alkaline phosphatase(ALP),ALB,and the proportion of parathyroid resection≥4 in SH group were significantly higher than those in the control group(P<0.05).Preoperative ALP(OR=1.442,95%CI:1.334-5.881),preoperative ALB(OR=1.391,95%CI:1.168-3.159)and the number of parathyroidectomy≥4(OR=2.248,95%CI:1.211-7.352)were independent risk factors for SH after PTX(P<0.05).The area under curve(AUC)predicted by preoperative ALB was 0.714(95%CI:0.577-0.850),and ACU predicted by preoperative ALP was 0.729(95%CI:0.586-0.872),without significant difference between the 2 groups(P>0.05).Conclusion:Preoperative ALB level is a risk factor for SH after PTX in SHPT patients.It has reference value for early screening high-risk groups of SH and predicting the occurrence of SH.