继发性甲状旁腺功能亢进患者甲状旁腺切除术后重度低钙血症相关因素分析

摘要

目的：探讨继发性甲状旁腺功能亢进（SHPT）患者甲状旁腺切除术后重度低钙血症（SHC）相关因素，进而建立SHC防治策略。方法回顾性分析2012年3月—2014年5月在我院行甲状旁腺切除治疗的S H P T病例资料。行单因素及多因素分析明确S HC的独立影响因素，确定定量因素界值。结果共收集88例病例资料，术后发生S HC46例（52.3％）。单因素分析显示年龄、ALP、iPTH、切除的甲状旁腺数（RTPN）具有统计学显著差异，多因素分析显示年龄、iPTH、RTPN≥4为SHC的独立影响因素，确定的界值为年龄48岁（PPV68.8％，NPV67.5％）和iPT H 1750 pg／ml（PPV85.4％，NPV87.5％）。结论年龄、甲状旁腺激素水平、甲状旁腺切除数量为SHPT患者甲状旁腺切除术后SHC的独立影响因素。选择性地对高危患者实施静脉补钙，选择合理的手术方式，可作为防治S HC的初步策略。%Objective To explore the factors associated with severe hypocalcemia(SHC) after parathyroidectomy for seconda‐ry hyperparathyroidism(SHPT) patients ,and to establish a strategy for the prevention and treatment of SHC .Methods A ret‐rospective study of clinical data was conducted in the cases of SHPT undergone parathyroidectomy in our hospital from Mar 2012 to May 2014 .Uni‐and multivariate analysis was conducted to define independent influence factors for the SHC ,and the cut‐off values of quantitative factors were defined .Results Eighty‐eight cases of clinical data were collected and the SHC was shown in 46 cases(52.3% ) after operation .Univariate analysis showed that age ,ALP ,iPTH and the resected parathyroid gland number(RTPN)emerged statistically significant difference ,and multivariate analysis showed that age ,iPTH and RTPN ≥4 were the independent influence factors for the SHC individually .The defined cut‐off values of age and iPTH were 48y (PPV68.8% ,NPV67.5% )and 1 750 pg/ml(PPV85.4% ,NPV87.5% ) ,respectively .Conclusion Age ,PT H level and the RT‐PN are the independent influence factors for the SHC after parathyroidectomy in SHPT patients .Selective intravenous supple‐mentation of calcium for the patients at high risk and selection of reasonable surgical manner can be established as preparatory strategy for the prevention and treatment of the SHC .