慢性肾脏病继发甲状旁腺功能亢进患者甲状旁腺全切术后骨饥饿综合征影响因素分析

Analysis of factors affecting hungry bone syndrome after total parathyroidectomy in patients with hyperparathyroidism secondary to chronic kidney disease

目的分析维持性血液透析治疗的慢性肾脏病合并难治性继发性甲状旁腺功能亢进(rSHPT)患者甲状旁腺全切除(tPTX)术后发生骨饥饿综合征(HBS)的影响因素。方法纳入行tPTX治疗的慢性肾脏病合并rSHPT患者116例。观察术后HBS发生情况并将患者分为HBS组和非HBS组。比较两组临床资料,选择单因素分析结果差异有统计学意义的因素纳入Logistic回归,分析HBS独立影响因素;采用多元线性回归分析HBS组患者静脉补钙时长和总补钙量的影响因素。结果术后88例(75.86%)患者发生HBS(HBS组)、28例未发生HBS(非HBS组)。HBS组男性比例、静脉补钙时长、总补钙量、术前全段甲状旁腺激素(iPTH)、手术前后碱性磷酸酶(ALP)水平高于非HBS组,年龄、术后1周血红蛋白、手术前后校正血钙水平低于非HBS组(P均<0.05)。Logistic回归分析结果显示,年龄、术前校正血钙、术后1周ALP是慢性肾脏病合并rSHPT患者tPTX术后发生HBS的独立影响因素(P均<0.05)。多元线性回归分析结果显示,年龄、术前iPTH、术后4 h校正血钙、术后血磷是HBS组总补钙量的独立影响因素(P均<0.05);年龄、术前iPTH、术后4 h校正血钙、ALP比值是HBS组静脉补钙时长的独立影响因素(P均<0.05)。结论年龄、术前血钙、术后ALP水平是慢性肾脏病合并rSHPT患者tPTX术后发生HBS的影响因素;低龄、术后4 h低血钙、术前高iPTH的患者术后补钙需求量更大。

Objective To analyze the factors influencing hungry bone syndrome(HBS)after total parathyroid resection(tPTX)in patients with chronic kidney disease complicated with refractory secondary hyperparathyroidism(rSHPT)undergoing maintenance hemodialysis.Methods Totally 116 chronic kidney disease patients with rSHPT undergoing tPTX were included.The occurrence of HBS was observed and patients were divided into HBS and non-HBS groups.We compared the clinical data of the two groups,and the items with statistically significant differences in univariate analysis were included in the Logistic regression to analyze the independent influencing factors,and multiple linear regression was used to analyze the influencing factors of intravenous calcium supplementation duration and total calcium supplementation in the HBS group.Results After parathyroidectomy,88 patients(75.86%)had HBS(HBS group)and 28 patients did not have HBS(non-HBS group).The proportion of men,length of intravenous calcium supplementation,total calcium supplementation,total preoperative parathyroid hormone(iPTH),alkaline phosphatase(ALP)levels before and after surgery in the HBS group were higher,and age,hemoglobin at 1 week after surgery,and corrected blood calcium levels before and after surgery were lower than those of the non-HBS group(all P<0.05).The results of Logistic regression analysis showed that age,preoperative corrected blood calcium,and 1-week postoperative ALP were independent influencing factors for HBS after tPTX in patients with rSHPT(all P<0.05).The results of multiple linear regression analysis showed that age,preoperative iPTH,postoperative 4 h corrected blood calcium,and postoperative blood phosphorus were independent influencing factors for the total calcium supplementation in HBS group(all P<0.05);age,preoperative iPTH,postoperative 4 h corrected blood calcium,and ALP ratio were independent influencing factors for the length of intravenous calcium supplementation in HBS group(all P<0.05).Conclusions Age,preoperative blood calcium,and postoperative ALP level were the influencing factors of HBS after tPTX in patients with chronic kidney disease and rSHPT.The postoperative calcium supplementation was greater in patients with young age,low blood calcium at 4 h after surgery,and high preoperative iPTH.