Abstract：
BACKGROUND: Vitamin D (Vit D) deficiency is common in patients with hyperparathyroidism, but the importance of replacement before surgery is controversial. It can be predicted that hypocalcemia risk will be higher in patients with high bone turnover.
OBJECTIVE: In this study, the effect of preoperative ALP/Vit D ratio on postoperative hypocalcemia was investigated.
METHODS: Among the primary hyperparathyroidism cases who were operated between 2015 and 2022, 158 patients with complete data were included in the study. Preoperative laboratory results, radiological images, and pathology reports of the patients were evaluated retrospectively. The cross-sectional value of the ALP/Vit D value predicting hypocalcemia was calculated. The effect of these parameters on postoperative hypocalcemia was investigated.
RESULTS: The mean age of our patients was 54 (21-81 years). When factors affecting postoperative hypocalcemia were evaluated by univariable analysis, Vit D deficiency and insufficiency (p < 0.001), ALP (p < 0.001), ALP/Vit D ratio (p < 0.001), and T score (p = 0.026) found to be factors affecting postoperative hypocalcemia. In multivariate analysis, the ALP/Vit D ratio was found to be an independent variable in predicting hypocalcemia. It was found that hypocalcemia was 45 times more common in patients with ALP/Vit D > 6.34 (p < 0.001). ALP/Vit D ratio predicts patients who will develop postoperative hypocalcemia with 87.2% sensitivity and 87.1% specificity.
CONCLUSIONS: Vit D deficiency increases the risk of postoperative hypocalcemia, but it is not sufficient alone to predict it. The risk increases more in patients with high bone turnover. The preoperative ALP/Vit D ratio is the strongest predictor of postoperative hypocalcemia risk.
OBJECTIVE: In this study, the effect of preoperative ALP/Vit D ratio on postoperative hypocalcemia was investigated.
METHODS: Among the primary hyperparathyroidism cases who were operated between 2015 and 2022, 158 patients with complete data were included in the study. Preoperative laboratory results, radiological images, and pathology reports of the patients were evaluated retrospectively. The cross-sectional value of the ALP/Vit D value predicting hypocalcemia was calculated. The effect of these parameters on postoperative hypocalcemia was investigated.
RESULTS: The mean age of our patients was 54 (21-81 years). When factors affecting postoperative hypocalcemia were evaluated by univariable analysis, Vit D deficiency and insufficiency (p < 0.001), ALP (p < 0.001), ALP/Vit D ratio (p < 0.001), and T score (p = 0.026) found to be factors affecting postoperative hypocalcemia. In multivariate analysis, the ALP/Vit D ratio was found to be an independent variable in predicting hypocalcemia. It was found that hypocalcemia was 45 times more common in patients with ALP/Vit D > 6.34 (p < 0.001). ALP/Vit D ratio predicts patients who will develop postoperative hypocalcemia with 87.2% sensitivity and 87.1% specificity.
CONCLUSIONS: Vit D deficiency increases the risk of postoperative hypocalcemia, but it is not sufficient alone to predict it. The risk increases more in patients with high bone turnover. The preoperative ALP/Vit D ratio is the strongest predictor of postoperative hypocalcemia risk.
摘要：
背景：甲状旁腺功能亢进患者维生素D（VitD）缺乏很常见，但是手术前更换的重要性是有争议的。可以预见，高骨转换患者的低钙血症风险会更高。
目的：在本研究中，研究术前ALP/VitD比值对术后低钙血症的影响.
方法：在2015年至2022年间进行手术的原发性甲状旁腺功能亢进病例中，有158例完整数据的患者被纳入研究。术前实验室检查结果,放射学图像，对患者的病理报告进行回顾性评估。计算预测低钙血症的ALP/VitD值的横截面值。研究了这些参数对术后低钙血症的影响。
结果：我们患者的平均年龄为54岁（21-81岁）。当单变量分析评估影响术后低钙血症的因素时，维生素D缺乏和不足(p<0.001)，ALP（p<0.001），ALP/VitD比值（p<0.001），T评分（p=0.026）是影响术后低钙血症的因素。在多变量分析中，ALP/VitD比值是预测低钙血症的独立变量.发现低钙血症在ALP/VitD>6.34的患者中更常见45倍（p<0.001）。ALP/VitD比值预测患者术后发生低钙血症的敏感性为87.2%，特异性为87.1%。
结论：维生素D缺乏会增加术后低钙血症的风险，但是仅仅预测它是不够的。高骨转换患者的风险增加更多。术前ALP/VitD比值是术后低钙血症风险的最强预测因子。
目的：在本研究中，研究术前ALP/VitD比值对术后低钙血症的影响.
方法：在2015年至2022年间进行手术的原发性甲状旁腺功能亢进病例中，有158例完整数据的患者被纳入研究。术前实验室检查结果,放射学图像，对患者的病理报告进行回顾性评估。计算预测低钙血症的ALP/VitD值的横截面值。研究了这些参数对术后低钙血症的影响。
结果：我们患者的平均年龄为54岁（21-81岁）。当单变量分析评估影响术后低钙血症的因素时，维生素D缺乏和不足(p<0.001)，ALP（p<0.001），ALP/VitD比值（p<0.001），T评分（p=0.026）是影响术后低钙血症的因素。在多变量分析中，ALP/VitD比值是预测低钙血症的独立变量.发现低钙血症在ALP/VitD>6.34的患者中更常见45倍（p<0.001）。ALP/VitD比值预测患者术后发生低钙血症的敏感性为87.2%，特异性为87.1%。
结论：维生素D缺乏会增加术后低钙血症的风险，但是仅仅预测它是不够的。高骨转换患者的风险增加更多。术前ALP/VitD比值是术后低钙血症风险的最强预测因子。
