维持性透析并发继发性甲状旁腺功能亢进患者甲状旁腺切除术后发生骨饥饿综合征的影响因素分析

An analysis of influencing factors for the occurrence of hunger bone syndrome after parathyroidectomy in maintenance dialysis patients with secondary hyperparathyroidism

目的分析维持性透析并发继发性甲状旁腺功能亢进(SHPT)患者甲状旁腺切除术(PTX)术后发生骨饥饿综合征(HBS)的影响因素。方法41例维持性透析并发SHPT患者行PTX,其中24例术后发生HBS(HBS组),17例未发生HBS(非HBS组)。收集患者临床资料,采用多因素logistic回归分析PTX术后发生HBS的影响因素,绘制ROC曲线评价骨代谢指标对PTX术后发生HBS的预测价值。结果与非HBS组相比,HBS组血液透析比例、术前3 d碱性磷酸酶(ALP)、抗酒石酸酸性磷酸酶5b(TRACP-5b)和术后1周ALP、骨钙素水平升高,而术前3 d血钙、全段甲状旁腺激素(iPTH)、25-羟维生素D[25-(OH)D]、骨钙素和术后1周血钙、iPTH、25-(OH)D水平降低(P<0.05)。术前3 d ALP水平升高是维持性透析并发SHPT患者行PTX术后发生HBS的独立危险因素(P<0.05),而术前3 d 25-(OH)D水平升高是其独立保护因素(P<0.05)。术前3 d ALP与25-(OH)D联合预测PTX术后发生HBS的AUC高于术前3 d ALP和25-(OH)D单独检测(0.934 vs.0.811和0.798)(P<0.05)。结论术前25-(OH)D和ALP水平是维持性透析并发SHPT患者PTX术后发生HBS的影响因素,两者联合检测对其具有较高的预测价值。

Objective To analyze the influencing factors for the occurrence of hunger bone syndrome(HBS)after parathyroidectomy(PTX)in the maintenance dialysis patients with secondary hyperparathyroidism(SHPT).Methods Of 41 maintenance dialysis patients with SHPT,HBS after PTX occurred in 24 cases(group A),and 17 cases did not have HBS after PTX(group B).The clinical data were collected.The influencing factors for the occurrence of HBS after PTX in the patients were analyzed by multivariate logistic regression.The predictive value of bone metabolism indicators in the occurrence of HBS after PTX was evaluated by ROC curve.Results Compared with group B,the proportion of maintenance hemodialysis,levels of ALP and TRACP-5b on the 3~(rd)day before surgery and the levels of ALP and osteocalcin on the 1~(st)day after surgery were increased,while the levels of serum calcium,iPTH,25-(OH)D and osteocalcin on the 3~(rd)day before surgery and the levels of serum calcium,iPTH and 25-(OH)D on the 1~(st)day after surgery were decreased in group A(P<0.05).The higher level of ALP on the 3~(rd)day before surgery was the independent risk factor for the occurrence of HBS after PTX in the maintenance dialysis patients with SHPT(P<0.05),while the higher level of 25-(OH)D on the 3~(rd)day before surgery was the independent protective factor(P<0.05).Combined detection of ALP and 25-(OH)D on the 3~(rd)day before surgery had a significant higher AUC in the prediction of occurrence of HBS after PTX than the AUC of ALP and 25-(OH)D on the 3~(rd)day before surgery detected alone(0.934 vs.0.811 and 0.798)(P<0.05).ConclusionThe levels of 25-(OH)D and ALP before surgery are the influencing factors for the occurrence of HBS after PTX in the maintenance dialysis patients with SHPT.Combined detection of them has a higher value in predicting the occurrence of HBS after PTX.