Division of Endocrine Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China.
World J Surg. 2013 Jul;37(7):1592-8. doi: 10.1007/s00268-013-2015-8.
Although previous studies have suggested that low preoperative 25-hydroxyvitamin D (25-OHD) is a risk factor for hypocalcemia after total thyroidectomy, the impact of preoperative 25-OHD on calcium (Ca)/parathyroid hormone (PTH) kinetics in the immediate postoperative period remains unclear. The study compared the postoperative Ca/PTH kinetics between different preoperative 25-OHD levels.
A total of 281 patients who underwent a total thyroidectomy were analyzed. Serum Ca was measured preoperatively within 1 h after surgery (Ca-D0) and on the following morning (Ca-D1). Preoperative 25-OHD was also measured after overnight fasting while postoperative PTH was checked at skin closure on day 0 (PTH-D0) and on the following morning on day 1 (PTH-D1). The Ca/PTH kinetics were compared between three groups (group I: preoperative 25-OHD < 10 ng/mL; group II: 25-OHD = 10-20 ng/mL; group III: 25-OHD > 20 ng/mL).
Group I had significantly lower preoperative Ca (p = 0.016) and Ca-D0 (p = 0.036) but higher PTH-D1 (p = 0.015) than groups II and III. PTH-D0, Ca-D1, and the rate of clinically significant hypocalcemia were similar in the three groups. Group I had a significantly smaller Ca drop (-0.02 vs. 0.01 and 0.02 mmol/L, p = 0.011) and a tendency for a significantly smaller PTH drop (0.4 vs. 0.5 and 1.0 pmol/L, p = 0.073) than groups II and III. PTH-D1 (OR = 1.550) and 25-OHD (OR = 0.958) were independent factors for Ca drop from day 0 to day 1.
Although group I began with lower serum Ca, those patients tended to have a greater PTH response to Ca drop and so preoperative 25-OHD did not significantly affect the overall Ca kinetics from preoperative to day 1.
虽然先前的研究表明，术前低 25-羟维生素 D（25-OHD）是全甲状腺切除术后低钙血症的危险因素，但术前 25-OHD 对术后即刻钙（Ca）/甲状旁腺激素（PTH）动力学的影响尚不清楚。本研究比较了不同术前 25-OHD 水平之间的术后 Ca/PTH 动力学。
分析了 281 例接受全甲状腺切除术的患者。在术前 1 小时内（Ca-D0）和术后次日清晨（Ca-D1）检测血清 Ca。术前 25-OHD 也在禁食过夜后测量，术后 PTH 在第 0 天（PTH-D0）和第 1 天（PTH-D1）关闭皮肤时检查。比较三组之间的 Ca/PTH 动力学（I 组：术前 25-OHD<10ng/mL；II 组：25-OHD=10-20ng/mL；III 组：25-OHD>20ng/mL）。
I 组术前 Ca（p=0.016）和 Ca-D0（p=0.036）明显低于 II 组和 III 组，而 PTH-D1（p=0.015）明显高于 II 组和 III 组。三组间 PTH-D0、Ca-D1 和临床显著低钙血症发生率相似。I 组 Ca 下降幅度明显小于 II 组和 III 组（-0.02 比 0.01 和 0.02mmol/L，p=0.011），PTH 下降幅度也有明显趋势（0.4 比 0.5 和 1.0pmol/L，p=0.073）。PTH-D1（OR=1.550）和 25-OHD（OR=0.958）是从第 0 天到第 1 天 Ca 下降的独立因素。
虽然 I 组开始时血清 Ca 较低，但这些患者倾向于对 Ca 下降有更大的 PTH 反应，因此术前 25-OHD 并未显著影响从术前到第 1 天的总体 Ca 动力学。
