背景:原发性甲状旁腺功能亢进(PHPT)患者在甲状旁腺切除术(PTX)后存在严重低钙血症(SH)的风险,但关于SH预测因素的数据有限。我们旨在确定PHPT患者PTX术后早期SH的危险因素,并评估临床参数的预测价值。
方法:对2010年1月至2022年12月接受PTX的PHPT患者进行了回顾性分析。共有46名患者被纳入研究,术后有15例(32.6%)经历SH,19(41.3%)在输尿管或肾脏有结石,和37(80.4%)患有骨质疏松症。根据术后血清钙水平将患者分为SH组和非SH组。术前生化指标,骨转换标记,分析肾功能指标,并与术后SH相关。
结果:术前血清钙(血清钙)差异有统计学意义(P<0.05),完整的甲状旁腺激素,血清磷(血清P),血清Ca/P,血清Ca下降百分比,总1型前胶原完整N端前肽,骨钙蛋白(OC),两组之间的碱性磷酸酶水平。多因素分析显示血清P(比值比[OR]=0.989;95%置信区间[95%CI]=0.981-0.996;P=0.003),血清钙(OR=0.007;95%CI=0.001-0.415;P=0.017),血清Ca/P(OR=0.135;95%CI=0.019-0.947;P=0.044)和OC水平(OR=1.012;95%CI=1.001-1.024;P=0.036)是术后早期SH的预测因子。受试者工作特征曲线分析显示血清P(曲线下面积[AUC]=0.859,P<0.001),血清Ca/P(AUC=0.735,P=0.010)和OC(AUC=0.729,P=0.013)具有较高的敏感性和特异性。
结论:术前血清P,血清Ca/P和骨钙蛋白水平可确定PHPT患者PTX术后早期SH的风险。
BACKGROUND: Patients with primary hyperparathyroidism (PHPT) are at risk for severe hypocalcemia (SH) following
parathyroidectomy (PTX), but limited data exist on the predictors of SH. We aimed to identify risk factors for early postoperative SH after PTX in patients with PHPT and to evaluate the predictive value of clinical parameters.
METHODS: A retrospective review of patients with PHPT who underwent PTX between January 2010 and December 2022 was performed. A total of 46 patients were included in the study, with 15 (32.6%) experiencing postoperative SH, 19 (41.3%) having calculi in the ureter or kidney, and 37 (80.4%) having osteoporosis. Patients were divided into SH and non-SH groups based on postoperative serum calcium levels. Preoperative biochemical indicators, bone turnover markers, and renal function parameters were analyzed and correlated with postoperative SH.
RESULTS: Statistically significant (P < 0.05) differences were found in preoperative serum calcium (serum Ca), intact parathyroid hormone, serum phosphorus (serum P), serum Ca/P, percentage decrease of serum Ca, total procollagen type 1 intact N-terminal propeptide, osteocalcin (OC), and alkaline phosphatase levels between the two groups. Multivariate analysis showed that serum P (odds ratio [OR] = 0.989; 95% confidence interval [95% CI] = 0.981-0.996; P = 0.003), serum Ca (OR = 0.007; 95% CI = 0.001-0.415; P = 0.017), serum Ca/P (OR = 0.135; 95% CI = 0.019-0.947; P = 0.044) and OC levels (OR = 1.012; 95% CI = 1.001-1.024; P = 0.036) were predictors of early postoperative SH. The receiver operating characteristic curve analysis revealed that serum P (area under the curve [AUC] = 0.859, P < 0.001), serum Ca/P (AUC = 0.735, P = 0.010) and OC (AUC = 0.729, P = 0.013) had high sensitivity and specificity.
CONCLUSIONS: Preoperative serum P, serum Ca/P and osteocalcin levels may identify patients with PHPT at risk for early postoperative SH after PTX.