甲状腺全切除术后血清全段甲状旁腺激素和血钙对永久性甲状旁腺功能减退症的预测价值

Predictive significance of serum intact parathyroid hormone and calcium in permanent hypoparathyroidism after total thyroidectomy

目的探讨甲状腺全切除术后血清全段甲状旁腺激素(intact parathyroid hormone,iPTH)和血钙对永久性甲状旁腺功能减退症(permanent hypoparathyroidism,PHPP)的预测价值,并观察与术后肾功能的关系。方法2019年7月~2021年7月于我院行甲状腺全切除术后6个月内PHPP的16例病人为PHPP组,同期术后6个月内未发生PHPP的48例病人为对照组。分析PHPP组病人术后1天、3天血清iPTH、血钙对甲状腺全切除术后PHPP预测效能及与术后6个月肾功能的关系。结果与对照组比,PHPP组术后1天、3天血清iPTH、血钙降低,术后6个月血尿素氮(blood urea nitrogen,BUN)、血肌酐(serum creatinine,SCr)增高,差异有统计学意义(P<0.05);PHPP组术后1天、3天血清iPTH、血钙与BUN、SCr均呈负相关(P<0.05);桥本甲状腺炎、肿瘤直径、甲状旁腺误切、术后1天、3天血清iPTH、血钙为甲状腺全切除术后PHPP的影响因素(P<0.05);受试者工作特征(receiver operating characteristic,ROC)曲线显示,术后1天血清iPTH、血钙联合预测的曲线下面积(area under the curve,AUC)最大。结论甲状腺全切除术后1天血清iPTH、血钙呈低表达,血清iPTH、血钙联合预测PHPP效能较高,与肾功能呈线性相关。

Objective To investigate the predictive significance of serum intact parathyroid hormone(iPTH)and calcium for permanent hypoparathyroidism(PHPP)after total thyroidectomy,and to observe the correlation with postoperative renal functional.Methods 16 PHPP patients 6 months after total thyroidectomy in Nanjing drum tower hospital from July 2019 to July 2021 were selected as the PHPP group.48 patients who did not develop PHPP within 6 months after surgery were randomly selected as the control group.The serum iPTH and calcium were compared between 2 groups before operation,1 d and 3 d after operation.The relationship between serum iPTH and calcium on the 1st and 3rd day after surgery and renal function in PHPP group after surgery were analyzed.The related influencing factors of PHPP after total thyroidectomy were analyzed.Results Compared with the control group,the serum iPTH and calcium on the 1st and 3rd day after operation were lower,the serum BUN and SCr at 6 months after operation were higher in the PHPP group(P<0.05).The serum iPTH and calcium 1 d and 3 d after operation were negatively correlated with the serum blood urea nitrogen(BUN)and serum creatinine,(SCr)in the PHPP grou(P<0.05).Logistic multivariate regression analysis showed that Hashimoto’s Thyroiditis,tumor size,parathyroid incision,serum iPTH and calcium on the 1st and 3rd day after surgery were influencing factors for PHPP after total thyroidectomy(P<0.05).The receiver operating characteristic curve(ROC)showed that the area under the curve(AUC)of the serum iPTH combined with calcium on the 1st after operation was the largest.Conclusion Serum iPTH and calcium are low expressed on the 1st after total thyroidectomy.The serum iPTH combined with calcium on the 1st after surgery has a high value in predicting PHPP,and are related to the renal function in patients.