尽管在接受甲状腺全切除术的患者中,在术前和术后都使用活性维生素D(VD)来预防低钙血症风险,1,25-二羟基维生素D(1,25(OH)2D)的作用尚未研究。这项研究全面调查了1,25(OH)2D对全甲状腺切除术后钙(Ca)浓度的影响。
■血清钙,甲状旁腺激素(PTH),对82例甲状腺疾病患者手术前后的1,25(OH)2D水平进行了检测。
■血清钙,PTH,1,25(OH)2D水平在术后第一天的早晨显着下降。值得注意的是,1,25(OH)2D浓度的降低显着低于PTH浓度(10.5±33.4%vs.52.1±30.1%,p<0.0001),28%的患者显示1,25(OH)2D增加。预测术后1,25(OH)2D降低的唯一因素是高的术前1,25(OH)2D浓度。术后1,25(OH)2D浓度,以及从术前水平下降的幅度和速度,显示与术前1,25(OH)2D浓度呈强正相关(所有三个变量p<0.0001),但与PTH浓度无关。这些发现表明,甲状腺切除术后的1,25(OH)2D浓度更强烈地依赖于术前浓度,而不是PTH降低的影响,并且相对保留。可能预防突然严重的术后低钙血症。高1,25(OH)2D水平是术后第一天低钙血症(<2mmol/L;p<0.05)的最重要的术前因素;然而,在术中增加因素时,仅PTH下降有统计学意义(p<0.001).在PTH>10pg/mL组中,1,25(OH)2D水平下降与术后低钙血症显著相关(p<0.05).同样,在PTH水平>15pg/mL组中,1,25(OH)2D浓度的下降是一个重要因素,PTH下降量不再显著。
■1,25(OH)2D在预防突发性、甲状腺全切除术后PTH水平降低导致严重的低钙血症,而术前1,25(OH)2D水平高是术后低钙血症的重要危险因素。优化术前方案以调整Ca,PTH,和1,25(OH)2D水平改善甲状腺全切除术患者的管理和防止术中PTH极端下降可能会降低低钙血症的风险。
UNASSIGNED: Although active vitamin D (VD) has been used both preoperatively and postoperatively to prevent hypocalcemia risk in patients undergoing total thyroidectomy, the role of 1,25-dihydroxyvitamin D (1,25(OH)2D) has not been examined. This
study comprehensively investigated the effects of 1,25(OH)2D on calcium (Ca) concentrations after total thyroidectomy.
UNASSIGNED: Serum Ca, parathyroid hormone (PTH), and 1,25(OH)2D levels were measured in 82 patients with thyroid disease before and after surgery.
UNASSIGNED: Serum Ca, PTH, and 1,25(OH)2D levels decreased significantly on the morning of the first postoperative day. Notably, the decrease in 1,25(OH)2D concentration was significantly lower than that of PTH concentration (10.5 ± 33.4% vs. 52.1 ± 30.1%, p<0.0001), with 28% of patients showing increases in 1,25(OH)2D. The only factor predicting a postoperative 1,25(OH)2D decrease was a high preoperative 1,25(OH)2D concentration. Postoperative 1,25(OH)2D concentrations, as well as the magnitude and rate of decrease from preoperative levels, showed strong positive correlations with preoperative 1,25(OH)2D concentrations (p<0.0001 for all three variables) but not with PTH concentrations. These findings suggest that 1,25(OH)2D concentrations after thyroidectomy were more strongly dependent on preoperative concentrations than on the effect of PTH decrease and were relatively preserved, possibly preventing sudden severe postoperative hypocalcemia. A high 1,25(OH)2D level was the most important preoperative factor for hypocalcemia (<2 mmol/L; p<0.05) on the first postoperative day; however, only PTH decrease was statistically significant (p<0.001) when intraoperative factors were added. In the PTH >10 pg/mL group, the decrease in 1,25(OH)2D levels was significantly associated with postoperative hypocalcemia (p<0.05). Similarly, in the PTH levels >15 pg/mL group, a decrease in 1,25(OH)2D concentration was a significant factor, and the amount of PTH decrease was no longer significant.
UNASSIGNED: 1,25(OH)2D plays an important role in preventing sudden, severe hypocalcemia due to decreased PTH levels after total thyroidectomy, whereas high preoperative 1,25(OH)2D levels are a significant risk factor for postoperative hypocalcemia. Optimizing preoperative protocols to adjust Ca, PTH, and 1,25(OH)2D levels to improve the management of patients undergoing total thyroidectomy and to prevent extreme intraoperative PTH decreases may reduce the risk of hypocalcemia.