原发性甲状旁腺功能亢进症患者术后血钙纵向变化规律及其影响因素分析

Postoperative longitudinal changes of serum calcium level and its influencing factors in patients with primary hyperparathyroidism

目的比较原发性甲状旁腺功能亢进症患者手术切除治疗前后血钙的变化规律。方法连续入选自1992年12月至2020年12月在北京积水潭医院手术治疗原发性甲状旁腺功能亢进症的271例患者,所有患者分别于术前、术中20 min、术后2周、术后1~6个月、术后7~12个月及术后1年后测量血钙浓度,并分析患者的性别、年龄、是否合并其他遗传性内分泌腺疾病、是否合并骨病变、是否合并肾结石等可能影响术后血钙水平的因素,利用广义估计方程分析不同类型患者手术前后血钙的变化规律。结果术后低钙血症最常发生在2周内,术后半年均为好发时期;男性、合并骨病变患者术后1~6个月与术后2周血钙值差异均无统计学意义(t=0.875,P=1.000;t=0.034,P=3.049);15~35岁年龄段患者术后1~6个月(t=0.239,P=1.000)和7~12个月(t=1.380,P=0.935)与术后2周血钙值差异均无统计学意义;骨密度变化值与术后血钙变化值相关(F=6.895,P=0.004)。结论甲状旁腺功能亢进症患者术后2周时低钙血症发生率最高,1年后血钙水平可能稳定在正常范围内;男性患者相较于女性患者在术后半年内血钙值仍处于较低水平;合并骨病变患者术后2周时血钙值更低并且回升较为缓慢;15~35岁患者术后1年内血钙值均处于较低水平。

Objective To compare the changes of serum calcium level before and after surgical resection in patients with primary hyperparathyroidism.Methods Two hundred and seventy-one patients with primary hyperparathyroidism were enrolled from Dec 1992 to Dec 2020 in Beijing Jishuitan Hospital.Serum calcium concentrations were measured before operation,20 min during surgery,then 2 weeks 1-6 months,7-12 months and 1 year respectively after operation.The baseline data of postoperative serum calcium such as sex,age,other genetic endocrine diseases,osteopathia and urolithiasis were calculated.The generalized estimation equation was used to analyze the changes of serum calcium in different types of patients before and after operation.Results The most common postoperative hypocalcemia occurred within 2 weeks,and it occurred frequently half a year after surgery.There was no significant difference in blood calcium between male patients(t=0.875,P=1.000)and patients with bone lesions(t=0.034,P=3.049)from 1 to 6 months after surgery and 2 weeks after surgery.Blood calcium level in patients aged 15-35 years old from 1 to 6 months(t=0.239,P=1.000),from 7 to 12 months(t=1.380,P=0.935)and 2 weeks after surgery was not statistically different.The change of bone mineral density was correlated with the change of blood calcium after operation(F=6.895,P=0.004).Conclusions The incidence of hypocalcemia was the highest in patients with hyperparathyroidism 2 weeks after surgery,and the blood calcium level was stable within the normal range 1 year later.The blood calcium value of male patients was still at a lower level than that of female patients within six months after surgery.In patients with bone disease,the blood calcium value was lower and recovered slowly 2 weeks after surgery.The blood calcium value of patients aged 15-35 was at a low level within 1 year after surgery.