Graves病女性患者术后手足搐搦的预测危险因素。

Predictive risk factors for postoperative tetany in female patients with Graves' disease.

作者信息

Yamashita H, Noguchi S, Murakami T, Uchino S, Watanabe S, Ohshima A, Toda M, Yamashita H, Kawamoto H

机构信息

Noguchi Thyroid Clinic and Hospital Foundation, Beppu, Oita, Japan.

出版信息

J Am Coll Surg. 2001 Apr;192(4):465-8. doi: 10.1016/s1072-7515(01)00803-1.

DOI:10.1016/s1072-7515(01)00803-1

PMID:11294403

Abstract

BACKGROUND

Postoperative tetany occurs in patients with secondary hyperparathyroidism caused by a deficiency in calcium and vitamin D concomitant with transient hypoparathyroidism induced by surgery. In the present study, we further clarified the risk factors by referring to serum 25-hydroxyvitamin D [25(OH)D] and alkaline phosphatase.

STUDY DESIGN

The serum levels of intact parathyroid hormone, calcium and other electrolytes, and 25-hydroxyvitamin D [25(OH)D] were measured preoperatively in 178 female patients with Graves' disease who underwent subtotal thyroidectomy.

RESULTS

Of the 178 female patients, 15 (8.4%) developed tetany. Univariate analysis of 16 possible risk factors showed that 2 were statistically significant: serum 25(OH)D and alkaline phosphatase levels. The incidence of tetany according to the serum levels of 25(OH)D and alkaline phosphatase was 19.1% (9/47) in patients with 25(OH)D < or = 25 nmol/L and alkaline phosphatase > 155, 11.8% (4/34) in those with 25(OH)D < or = 25 nmol/L and alkaline phosphatase < or = 155, 6.7% (2/30) in those with 25(OH)D > 25 nmol/L and alkaline phosphatase > 155, and 0% (0/50) in those with 25(OH)D > 25 nmol/L and alkaline phosphatase < or = 155.

CONCLUSIONS

Patients with Graves' disease who have vitamin D deficiency with high serum alkaline phosphatase levels are the highest-risk group for postoperative tetany. Serum 25(OH)D and alkaline phosphatase should be monitored in patients with Graves' disease.

摘要

背景

术后手足抽搐发生于因钙和维生素D缺乏导致继发性甲状旁腺功能亢进且伴有手术诱发的暂时性甲状旁腺功能减退的患者。在本研究中，我们通过参考血清25-羟维生素D[25(OH)D]和碱性磷酸酶进一步明确了危险因素。

研究设计

对178例接受甲状腺次全切除术的Graves病女性患者术前测定了血清完整甲状旁腺激素、钙及其他电解质水平以及25-羟维生素D[25(OH)D]水平。

结果

178例女性患者中，15例（8.4%）发生了手足抽搐。对16个可能的危险因素进行单因素分析显示，有2个因素具有统计学意义：血清25(OH)D和碱性磷酸酶水平。根据血清25(OH)D和碱性磷酸酶水平，25(OH)D≤25 nmol/L且碱性磷酸酶>155的患者手足抽搐发生率为19.1%（9/47），25(OH)D≤25 nmol/L且碱性磷酸酶≤155的患者为11.8%（4/34），25(OH)D>25 nmol/L且碱性磷酸酶>155的患者为6.7%（2/30），25(OH)D>25 nmol/L且碱性磷酸酶≤155的患者为0%（0/50）。