Díez Manuel, Vera Cristina, Ratia Tomás, Diego Lucía, Mendoza Fernando, Guillamot Paloma, San Román Rosario, Mugüerza José M, Rodríguez Angel, Medina Carlos, Gómez Beatriz, Granell Javier
Servicio de Cirugía General, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá de Henares, Madrid, Spain.
Cir Esp. 2013 Apr;91(4):250-6. doi: 10.1016/j.ciresp.2012.09.006. Epub 2012 Nov 30.
The purpose of this study was to analyse the relationship between preoperative serum levels of vitamin D and postoperative hypocalcaemia after total thyroidectomy.
A prospective observational study was conducted on 113 patients treated by total thyroidectomy due to benign disease. Preoperative vitamin D serum levels and postoperative albumin-corrected calcium and parathormone (PTH) levels were determined. Sensitivity, specificity, positive predictive value and negative predictive value of vitamin D and PTH levels, respectively, in the diagnosis of postoperative hypocalcaemia were calculated.
Hypocalcaemia was diagnosed in 44 (38.9%) patients. Vitamin D levels were significantly higher in the group of patients with normal postoperative calcium (median: 25.4pg/mL; range: 4-60), compared to those who developed hypocalcaemia (median: 16.4pg/mL; range: 6.3-46.9) (P=.001). Postoperative hypocalcaemia was more frequent in patients with vitamin D < 30ng/mL (39/78) (50%), than among those with normal levels (5/35) (14.2%) (P=.001). Sensitivity, specificity, positive predictive value and negative predictive value were 88% and 68%, 43% and 82%, 50% and 71%, and 85% and 80% for vitamin D and PTH, respectively. Vitamin D and PTH showed independent prognostic values on the risk of hypocalcaemia. The OR associated with vitamin D < 30ng/mL was 4.25 (95% CI: 1.31-13.78) (P=.016), and the OR of PTH<13pg/mL was 15.4 (95% CI: 4.83-49.1) (P<.001).
Vitamin D deficiency is a risk factor of hypocalcaemia after total thyroidectomy for benign goitre. The vitamin D level provides independent prognostic information, which is complementary to that given by PTH.
本研究旨在分析甲状腺全切除术后术前血清维生素D水平与术后低钙血症之间的关系。
对113例因良性疾病接受甲状腺全切除术的患者进行了一项前瞻性观察研究。测定术前维生素D血清水平以及术后白蛋白校正钙和甲状旁腺激素（PTH）水平。分别计算维生素D和PTH水平在诊断术后低钙血症中的敏感性、特异性、阳性预测值和阴性预测值。
44例（38.9%）患者被诊断为低钙血症。术后血钙正常的患者组维生素D水平显著高于发生低钙血症的患者组（中位数：25.4pg/mL；范围：4 - 60），分别为（中位数：16.4pg/mL；范围：6.3 - 46.9）（P = 0.001）。维生素D<30ng/mL的患者术后低钙血症发生率更高（39/78）（50%），高于维生素D水平正常的患者（5/35）（14.2%）（P = 0.001）。维生素D和PTH在诊断术后低钙血症中的敏感性、特异性、阳性预测值和阴性预测值分别为88%和68%、43%和82%、50%和71%、85%和80%。维生素D和PTH对低钙血症风险具有独立的预后价值。维生素D<30ng/mL的OR为4.25（95%CI：1.31 - 13.78）（P = 0.016），PTH<13pg/mL的OR为15.4（95%CI：4.83 - 49.1）（P<0.001）。
维生素D缺乏是良性甲状腺肿甲状腺全切除术后低钙血症的一个危险因素。维生素D水平提供独立的预后信息，这与PTH提供的信息互补。
