术后甲状旁腺激素（PTH）与PTH梯度对比作为甲状腺切除术后低钙血症的预测指标
Postoperative IPTH compared with IPTH gradient as predictors of post-thyroidectomy hypocalcemia.
作者信息
Al Khadem Mai G, Rettig Eleni M, Dhillon Vaninder K, Russell Jonathon O, Tufano Ralph P
机构信息
Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
出版信息
Laryngoscope. 2018 Mar;128(3):769-774. doi: 10.1002/lary.26805. Epub 2017 Aug 26.
OBJECTIVES/HYPOTHESIS: Predicting patients' risk for hypocalcemia after thyroidectomy may allow for same-day discharge. This study was designed to compare postoperative intact parathyroid hormone (IPTH) alone with percentage change in IPTH (IPTH gradient) in predicting post-thyroidectomy hypocalcemia.
STUDY DESIGN
Retrospective cohort study.
METHODS
Patients undergoing total thyroidectomy by the senior author from May 2015 to May 2016 were included. Serum IPTH was measured preoperatively and 1 hour postoperatively, and IPTH gradient was calculated. Postoperative hypocalcemia was mild (≥8.0, <8.4) or severe (<8.0 and/or hypocalcemic symptoms). Postoperative IPTH and IPTH gradient were compared with hypocalcemia using logistic regression. Receiver operating characteristic analysis of IPTH measures as predictors of hypocalcemia was performed, and the area under the curve (AUC) was calculated.
RESULTS
Overall, 119 patients were included. Forty-seven percent of the patients developed postoperative hypocalcemia, including 26 (22%) with mild and 30 (25%) with severe hypocalcemia. Thirteen patients had hypocalcemic symptoms. Median IPTH gradient and postoperative IPTH each differed significantly by category of hypocalcemia (P < .001). Higher IPTH gradient was significantly associated with odds of severe and symptomatic hypocalcemia (adjusted odds ratio [aOR]: 1.21, 95% confidence interval [CI]: 1.06-1.39 and aOR: 1.34, 95% CI: 1.05-1.71 per 10% increase), whereas lower postoperative IPTH was not (aOR: 1.27, 95% CI: 0.95-1.68 and aOR: 1.44, 95% CI: 0.90-2.31 per 10 pg/mL decrease). The AUC for predicting severe hypocalcemia was nonsignificantly higher for IPTH gradient than postoperative IPTH (AUC = 0.77 vs. 0.69, P = .10). The AUC for predicting symptomatic hypocalcemia was significantly higher for IPTH gradient (AUC = 0.75 vs. 0.72, P = .03).
CONCLUSIONS
Our results suggest that the IPTH gradient may be more useful than postoperative IPTH alone in predicting risk of post-thyroidectomy hypocalcemia.
LEVEL OF EVIDENCE
- Laryngoscope, 128:769-774, 2018.
目的/假设：预测甲状腺切除术后患者发生低钙血症的风险可能有助于当日出院。本研究旨在比较单独使用术后完整甲状旁腺激素（IPTH）与IPTH百分比变化（IPTH梯度）在预测甲状腺切除术后低钙血症方面的效果。
研究设计
回顾性队列研究。
方法
纳入2015年5月至2016年5月由资深作者实施全甲状腺切除术的患者。术前及术后1小时测量血清IPTH，并计算IPTH梯度。术后低钙血症分为轻度（≥8.0，<8.4）或重度（<8.0和/或有低钙血症症状）。使用逻辑回归比较术后IPTH和IPTH梯度与低钙血症的关系。对IPTH测量值作为低钙血症预测指标进行受试者操作特征分析，并计算曲线下面积（AUC）。
结果
总共纳入119例患者。47%的患者发生术后低钙血症，其中26例（22%）为轻度，30例（25%）为重度。13例患者有低钙血症症状。IPTH梯度中位数和术后IPTH在低钙血症类别间均有显著差异（P <.001）。较高的IPTH梯度与重度和有症状低钙血症的几率显著相关（调整优势比[aOR]：1.21，95%置信区间[CI]：1.06 - 1.39；每增加10%，aOR：1.34，95% CI：1.05 - 1.71），而术后IPTH降低则无此关联（每降低10 pg/mL，aOR：1.27，95% CI：0.95 - 1.68；aOR：1.44，95% CI：0.90 - 2.31）。预测重度低钙血症时，IPTH梯度的AUC略高于术后IPTH，但差异无统计学意义（AUC = 0.77对0.69，P =.10）。预测有症状低钙血症时，IPTH梯度的AUC显著更高（AUC = 0.75对0.72，P =.03）。
结论
我们的结果表明，在预测甲状腺切除术后低钙血症风险方面，IPTH梯度可能比单独的术后IPTH更有用。
证据级别
4。《喉镜》，128:769 - 774，2018年。
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