继发性甲状旁腺功能亢进症患者术后发生骨饥饿综合征的影响因素分析

Analysis of factors influencing hungry bone syndrome in patients with secondary hyperparathyroidism after parathyroidectomy

目的 分析继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)患者行甲状旁腺切除术后发生骨饥饿综合征(hungry bone syndrome,HBS)的影响因素。方法 回顾性分析2016年1月至2021年5月期间在联勤保障部队第九〇〇医院因SHPT接受甲状旁腺切除术患者的临床资料,采用二分类logistic回归方法分析HBS发生的危险因素,采用受试者操作特征曲线分析危险因素预测术后发生HBS的最佳临界值。结果 本研究共纳入符合研究条件的患者89例,男44例、女45例,年龄(47±11)岁,发生HBS患者42例(47.2%)。与未发生HBS患者相比,发生HBS患者年龄更小(P<0.05),术前甲状旁腺激素、钾、碱性磷酸酶(alkaline phosphatase,ALP)水平更高(P<0.05)。多因素二分类logistic回归分析结果显示,术前ALP水平增高是HBS发生的危险因素[OR(95%CI)=1.014(1.007,1.020),P<0.001],它区分发生和不发生HBS患者的受试者操作特征曲线下面积(95%CI)为0.957(0.919,0.996),且ALP的最佳临界值为278.90 U/L。结论 从本研究结果中得出,对于SHPT行甲状旁腺切除术后患者,可根据术前ALP水平区分骨转换状态,当患者术前ALP水平高于临界值278.90 U/L时,建议尽早给予补钙且密切监测血钙水平。

Objective To analyze the factors influencing the hungry bone syndrome(HBS)in patients with secondary hyperparathyroidism(SHPT)after parathyroidectomy.Methods The clinical data of patients who underwent parathyroidectomy for SHPT in the 900th Hospital of the Joint Logistics Support Force from January 2016 to May 2021 were retrospectively analyzed.The risk factors for HBS were analyzed by binary logistic regression analysis.The cut-off value of risk factors for predicting postoperative HBS was analyzed by using recieve operating characteristic(ROC)curve.Results A total of 89 patients were included in this study,including 44 males and 45 females,with(47±11)years old.There were 42(47.2%)patients with HBS.Compared with the patients without HBS,the patients with HBS was younger and had higher levels of preoperative parathyroid hormone,potassium,and alkaline phosphatase(ALP),the differences were statistically different(P<0.05).The multivariate binary logistic regression analysis showed that the higher preoperative ALP level was a risk factor for the HBS[OR(95%CI)=1.014(1.007,1.020),P<0.001].The area under the ROC curve(95%CI)of the preoperative ALP level in distinguishing the patients with HBS from without HBS was 0.957 (0.919, 0.996), and the optimal cut-off value of ALP for predicting postoperative HBS was 278.90 U/L.Conclusions From the preliminary results of this study, it can be concluded that bone conversion status can bedifferentiated according to preoperative ALP level in patients with SHPT. When preoperative ALP level is higher than cutoff value, it is recommended that calcium supplementation should be given as soon as possible and blood calcium levelshould be closely monitored.