血清全段甲状旁腺激素浓度对甲状腺全切除术后发生永久性甲状旁腺功能减退症的预测效果

doi:10.3969/j.issn.1006-7795.2021.01.025

首都医科大学学报 ›› 2021, Vol. 42 ›› Issue (1): 148-152.doi: 10.3969/j.issn.1006-7795.2021.01.025

血清全段甲状旁腺激素浓度对甲状腺全切除术后发生永久性甲状旁腺功能减退症的预测效果

蔡淑艳, 郑建伟^*

首都医科大学附属北京朝阳医院普通外科,北京 100043

收稿日期:2020-04-26 出版日期:2021-02-21 发布日期:2021-02-02

The predictive effect of serum intact parathyroid hormone (iPTH) levels on permanent hypoparathyroidism in patients after total thyroidectomy

Cai Shuyan, Zheng Jianwei^*

Department of General Surgery, Beijing Chaoyang Hospital,Capital Medical University, Beijing 100043, China

Received:2020-04-26 Online:2021-02-21 Published:2021-02-02
Contact: ^*E-mail:zhengjw1116@qq.com

摘要/Abstract

摘要： 目的探讨甲状腺全切除术后 24 h全段甲状旁腺激素(intact parathyroid hormone, iPTH)浓度与永久性甲状旁腺功能减退(permanent hypoparathyroidism, pHPP) 的关系及其预测效果。方法收集首都医科大学附属北京朝阳医院普外科 2008 年 12 月至 2019 年 12 月期间,行甲状腺全切除的共 622 例甲状腺癌及甲状腺良性病变患者的病例资料。采用单因素及多因素 Logistic 回归分析术后 24 h iPTH 与术后发生永久性甲状旁腺功能减退的相关性;采用受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC),评估发生永久性甲状旁腺功能减退症的预测效力。结果 622 例患者中,发生永久性甲状旁腺功能减退的患者共 25 例,发生率为 4.02%(25/622),多因素分析显示,术后第1天测定的 iPTH(OR=2.815, 95% CI:1.169~6.781,P=0.021)是术后发生永久性甲状旁腺功能减退的独立预测危险因素。AUC为0.974(95%CI:0.958~0.985,P< 0.001),iPTH 浓度 5.45 pg/mL 为临界值。预测的灵敏度为100%,特异度为 88.6%,Kappa=0.385。结论甲状腺全切除术后第1天测定的 iPTH浓度和术后发生永久性甲状旁腺功能低下密切相关临床预测的灵敏度高,但总一致性较差,临床应用误差较高,需要注意。

关键词: 甲状腺全切除术, 术后低钙血症, 永久性甲状旁腺功能减退症

Abstract: Objective To determine intact parathyroid hormone (iPTH) levels at 24 hours after total thyroidectomy, to predict the occurrence of permanent hypoparathyroidism (pHPP), and to analyze the clinical value of parathyroid hormone as an independent risk factor for predicting hypoparathyroidism. Methods Totally 622 patients with thyroid cancer and benign thyroid lesions who underwent total thyroidectomy at Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University from December 2008 to December 2019 were studied retrospectively. Independent sample t test and Chi-square test were used to analyze and compare serum iPTH levels, and multivariate Logistic regression analysis was applied to evaluate the correlation between each data and the occurrence of permanent hypoparathyroidism after surgery. The area under the receiver operating characteristic (ROC) curve (AUC) was used to calculate iPTH levels to predict the accuracy of permanent hypoparathyroidism. Results Among the 622 cases of total thyroidectomy, 25 cases of permanent hypoparathyroidism occurred, with an incidence of 4.02% (25/622). Multivariate analysis showed that iPTH level on postoperative day 1(OR=2.815, 95% CI:1.169-6.781,P=0.021) was independent risk factor for postoperative permanent hypoparathyroidism. The concentration of iPTH threshold value was 5.45 pg/mL (AUC 0.974, 95%CI: 0.958-0.985,P<0.001) at 24 hours after total thyroidectomy. Conclusions Serum iPTH level measured on the first day after total thyroidectomy was closely related to the occurrence of permanent hypoparathyroidism postoperatively, It was an independent predictor of risk factors.

Key words: total thyroidectomy, postoperative hypocalcemia, permanent hypoparathyroidism

中图分类号:

R653

蔡淑艳, 郑建伟. 血清全段甲状旁腺激素浓度对甲状腺全切除术后发生永久性甲状旁腺功能减退症的预测效果[J]. 首都医科大学学报, 2021, 42(1): 148-152.

Cai Shuyan, Zheng Jianwei. The predictive effect of serum intact parathyroid hormone (iPTH) levels on permanent hypoparathyroidism in patients after total thyroidectomy[J]. Journal of Capital Medical University, 2021, 42(1): 148-152.

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血清全段甲状旁腺激素浓度对甲状腺全切除术后发生永久性甲状旁腺功能减退症的预测效果

The predictive effect of serum intact parathyroid hormone (iPTH) levels on permanent hypoparathyroidism in patients after total thyroidectomy

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