术前维生素 D 缺乏症可预测全甲状腺切除术后低钙血症。

Preoperative vitamin D deficiency predicts postoperative hypocalcemia after total thyroidectomy.

机构信息

Department of Endocrine Surgery, Hammersmith Hospital, Imperial College NHS Trust, Du Cane Road, London, W12 0HS, UK.

出版信息

World J Surg. 2011 Feb;35(2):324-30. doi: 10.1007/s00268-010-0872-y.

DOI:10.1007/s00268-010-0872-y

PMID:21153820

Abstract

BACKGROUND

Transient postthyroidectomy hypocalcemia occurs in up to 30% of patients. We evaluated the effect of vitamin D deficiency on postthyroidectomy hypocalcemia.

METHODS

Data were collected prospectively between January 2006 and March 2009. A total of 166 consecutive total thyroidectomies were analyzed regarding the relation between preoperative vitamin D3 levels and postoperative corrected calcium levels. Patients were divided into three groups dependent upon the preoperative vitamin D3 level: group 1, <25 nmol/l; group 2, 25-50 nmol/l; group 3, >50 nmol/l (conversion factor of 2.5× between nanomoles per liter and nanograms per milliliter). Hypocalcemia was defined as a postoperative calcium level<2.00 mmol/l (8 mg/dl). Hospital length of stay was recorded.

RESULTS

There was a difference in postoperative hypocalcemia between the three vitamin D3 groups (group 1 (32%) vs. group 2 (24%) vs. group 3 (13%). Hypocalcemia in group 1 (vit D<25 nmol/l, <10 ng/ml) was significantly more likely than in group 3 (vit D>50 nmol/l, >20 ng/ml) (P=0.025, χ2 test. Vitamin D3 deficiency was also associated with a longer hospital stay (median stay 2 days vs. 1 day, P<0.001, Wilcoxon rank test).

CONCLUSIONS

There is a significant difference in postoperative hypocalcemia rates between those with vitamin D levels>50 nmol/l (>20 ng/ml) and those with a level of <25 nmol/l (<10 ng/ml). Vitamin D deficiency leads to a delay in discharge owing to a higher likelihood of hypocalcemia.

摘要

背景

甲状腺切除术后短暂性低钙血症在多达 30%的患者中发生。我们评估了维生素 D 缺乏对甲状腺切除术后低钙血症的影响。

方法

数据于 2006 年 1 月至 2009 年 3 月期间前瞻性收集。总共分析了 166 例连续行甲状腺全切除术患者的术前维生素 D3 水平与术后校正钙水平之间的关系。根据术前维生素 D3 水平将患者分为三组：组 1，<25 nmol/l；组 2，25-50 nmol/l；组 3，>50 nmol/l（纳米摩尔/升与纳克/毫升之间的转换系数为 2.5×）。低钙血症定义为术后血钙水平<2.00 mmol/l（8 mg/dl）。记录住院时间。

结果

三组维生素 D3 之间术后低钙血症发生率存在差异（组 1（32%）vs. 组 2（24%）vs. 组 3（13%））。组 1（维生素 D<25 nmol/l，<10 ng/ml）的低钙血症发生率明显高于组 3（维生素 D>50 nmol/l，>20 ng/ml）（P=0.025，χ2 检验。维生素 D3 缺乏还与住院时间延长相关（中位数住院时间 2 天 vs. 1 天，P<0.001，Wilcoxon 秩检验）。