Torer N, Torun D, Torer N, Micozkadioglu H, Noyan T, Ozdemir F N, Haberal M
Nephrology Department, Baskent University Faculty of Medicine, Ankara, Turkey.
Transplant Proc. 2009 Nov;41(9):3642-6. doi: 10.1016/j.transproceed.2009.06.207.
We sought to investigate predictors of early development of postoperative hypocalcemia in secondary hyperparathyroidism. Thirty-six hemodialysis patients (21 men, 15 women; mean age, 39.6 +/- 13.2 years; mean hemodialysis duration, 77.9 +/- 47.1 months) underwent parathyroidectomy. We recorded preoperative adjusted serum calcium (Ca(+2)), phosphate, alkaline phosphatase, intact parathyroid hormone, and hemoglobin levels; mean systolic and diastolic blood pressure levels; parathyroid ultrasonography and scintigraphic data; and number and weight of the resected adenomas. Patients were divided into two groups based on Ca(+2) levels within 24 hours of parathyroidectomy: the hypocalcemia group (serum Ca(+2) levels < or = 8 mg/dL; n = 26 patients) and the normocalcemia group (>8 mg/dL; n = 10 patients). A total parathyroidectomy with autotransplant was performed in 23 patients and a subtotal parathyroidectomy in 13 patients. Age (36.0 +/- 9.7 vs 49.2 +/- 16.6 years; P = .006); levels of preoperative serum Ca(+2) (9.6 +/- 0.7 vs 10.4 +/- 1.1 mg/dL; P = .01), alkaline phosphatase (346.7 +/- 354.7 vs 653.3 +/- 553.7 mg/dL; P = .05), and hemoglobin (10.5 +/- 1.4 vs 12.3 +/- 2.5 g/dL; P = .009); and number (2.0 +/- 1.3 vs 2.9 +/- 0.9; P = .04) and weight (1.9 +/- 2.1 vs 3.2 +/- 1.7; P = .01) of excised parathyroid adenomas were significantly lower among the hypocalcemia than the normocalcemia group. Among hemodialysis patients with secondary hyperparathyroidism, age, levels of preoperative serum Ca(+2) and alkaline phosphatase, and number and weight of adenomas were associated with early development of postoperative hypocalcemia.
我们试图研究继发性甲状旁腺功能亢进症患者术后早期发生低钙血症的预测因素。36例血液透析患者（21例男性，15例女性；平均年龄39.6±13.2岁；平均血液透析时间77.9±47.1个月）接受了甲状旁腺切除术。我们记录了术前校正血清钙（Ca(+2)）、磷酸盐、碱性磷酸酶、完整甲状旁腺激素和血红蛋白水平；平均收缩压和舒张压水平；甲状旁腺超声和闪烁扫描数据；以及切除腺瘤的数量和重量。根据甲状旁腺切除术后24小时内的Ca(+2)水平将患者分为两组：低钙血症组（血清Ca(+2)水平≤8mg/dL；n = 26例患者）和正常钙血症组（>8mg/dL；n = 10例患者）。23例患者行甲状旁腺全切术并自体移植，13例患者行甲状旁腺次全切除术。低钙血症组患者的年龄（36.0±9.7岁 vs 49.2±16.6岁；P = 0.006）、术前血清Ca(+2)水平（9.6±0.7mg/dL vs 10.4±1.1mg/dL；P = 0.01）、碱性磷酸酶水平（346.7±354.7mg/dL vs 653.3±553.7mg/dL；P = 0.05）和血红蛋白水平（10.5±1.4g/dL vs 12.3±2.5g/dL；P = 0.009）以及切除甲状旁腺腺瘤的数量（2.0±1.3个 vs 2.9±0.9个；P = 0.04）和重量（1.9±2.1g vs 3.2±1.7g；P = 0.01）均显著低于正常钙血症组。在继发性甲状旁腺功能亢进症的血液透析患者中，年龄、术前血清Ca(+2)和碱性磷酸酶水平以及腺瘤的数量和重量与术后早期低钙血症的发生有关。
