摘要
目的探讨甲状腺全切除术后第一天全段甲状旁腺激素(iPTH)水平评估术后发生永久性甲状旁腺功能减退症(PHPP)的价值。方法回顾性分析首都医科大学附属北京朝阳医院普通外科2008年2月至2018年12月546例行甲状腺全切除术的甲状腺癌及甲状腺良性病变患者的资料。男性158例,女性388例,年龄(50.9±13.2)岁(范围:19.0~79.2岁)。收集患者术前、术后第1天和术后6个月的血钙和iPTH水平。采用Logistic回归分析各临床指标与术后发生PHPP的相关性。采用受试者工作特征曲线下面积评估iPTH对术后发生PHPP的预测效力。结果22例患者发生PHPP,发生率为4.0%(22/546)。多因素分析结果显示,术后第1天iPTH(OR=2.932,95%CI:1.129~7.616,P=0.027)和血钙水平(OR=2.584,95%CI:1.017~6.567,P=0.046)是术后发生PHPP的独立预后因素。以术后第1天iPTH 5.51 ng/L为临界值,预测术后发生PHPP的曲线下面积为0.956(95%CI:0.936~0.972,P=0.000),灵敏度为100%,特异度为85.1%,阳性预测值为22%,阴性预测值为100%。以术后血钙1.93 mmol/L为临界值,预测术后发生PHPP的曲线下面积为0.733(95%CI:0.694~0.770,P=0.000),灵敏度为63.6%,特异度为78.1%,阳性预测值为10.8%,阴性预测值为98.1%。结论甲状腺全切除术后第1天iPTH和血钙水平与术后发生PHPP相关,iPTH的预测效力高于血钙。
Objective To examine the value serum calcium and intact parathyroid hormone(iPTH)levels measured on the first day after total thyroidectomy on prediction for permanent hypoparathyroidism.Methods Totally 546 patients with thyroid cancer and benign thyroid lesions who underwent total thyroidectomy at Department of General Surgery,Beijing Chaoyang Hospital,Capital Medical University from February 2008 to December 2018 were analyzed retrospectively.There were 158 males and 388 females aging(50.9±13.2)years(range:19.0 to 79.2 years).Serum calcium and iPTH levels were collected before surgery,on the first day and 6 months after surgery.Logistic regression was used to analyze the correlation between each data and the occurrence of permanent hypoparathyroidism after surgery.The area under the receiver operating characteristic curve was used to evaluate the predictive power of iPTH for postoperative occurrence of permanent hypoparathyroidism.Results Among the 546 cases of total thyroidectomy,22 cases of permanent hypoparathyroidism occurred,with an incidence of 4.0%(22/546).Multivariate analysis showed that iPTH levels on the first day after total thyroidectomy(OR=2.932,95%CI:1.129 to 7.616,P=0.027)and serum calcium levels(OR=2.584,95%CI:1.017 to 6.567,P=0.046)were independent prognosis factors for postoperative permanent hypoparathyroidism.When the threshold value of iPTH at 24 hours after total thyroidectomy was 5.51 ng/L,the AUC was 0.956(95%CI:0.936 to 0.972,P=0.000),sensitivity was 100%,specificity was 85.1%,positive predictive value was 22%,negative predictive value was 100%.When the threshold value of serum calcium at 24 hours after total thyroidectomy was 1.93 mmol/L,the AUC was 0.733(95%CI:0.694 to 0.770,P=0.000),sensitivity was 63.6%,specificity was 78.1%,positive predictive value of 10.8%and negative predictive value of 98.1%.Conclusions Serum iPTH and calcium levels on the first day after total thyroidectomy were related to the occurrence of permanent hypoparathyroidism postoperatively.The predictive value of iPTH level is higher than that of serum calcium level.
作者
郑建伟
蔡淑艳
宋慧敏
王云雷
韩晓风
吴浩良
韩刚
高志刚
Zheng Jianwei;Cai Shuyan;Song Huimin;Wang Yunlei;Han Xiaofeng;Wu Haoliang;Han Gang;Gao Zhigang(Department of General Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2020年第8期626-630,共5页
Chinese Journal of Surgery
