Yang Meng, Zhang Ling, Huang Linping, Sun Xiaoliang, Ji Haoyang, Lu Yao
Am Surg. 2017 Dec 1;83(12):1368-1372.
Elevated preoperative levels of alkaline phosphatase (ALP) in patients with refractory secondary hyperparathyroidism are correlated with postoperative hypocalcemia and mortality. The aim of this study was to identify the predictors of preoperative ALP in patients with secondary hyperparathyroidism. From April 2012 to December 2015, 220 patients with refractory secondary hyperparathyroidism undergoing total parathyroidectomy without autotransplantation were reviewed. A total of 164 patients presented with elevated preoperative ALP. Univariate analysis showed that patients with elevated ALP were significantly younger. The elevated ALP group had significantly higher levels of preoperative parathyroid hormone (PTH), lower preoperative serum calcium, higher preoperative phosphorus, lower postoperative hypocalcemia, and a longer hospital stay. Logistic regression analysis showed that elevated preoperative PTH was a significant independent risk factor for elevated preoperative ALP (P = 0.000), and its value of 1624 pg/mL was the optimal cutoff point. Factors predictive of elevated preoperative ALP in patients with secondary hyperparathyroidism include preoperative PTH. Earlier surgery, aggressive calcium supplementation, and more careful or aggressive postoperative care for high-risk patients are needed.
难治性继发性甲状旁腺功能亢进患者术前碱性磷酸酶（ALP）水平升高与术后低钙血症及死亡率相关。本研究旨在确定继发性甲状旁腺功能亢进患者术前ALP的预测因素。回顾了2012年4月至2015年12月期间220例行甲状旁腺全切术且未进行自体移植的难治性继发性甲状旁腺功能亢进患者。共有164例患者术前ALP升高。单因素分析显示，ALP升高的患者明显更年轻。ALP升高组术前甲状旁腺激素（PTH）水平显著更高，术前血清钙水平更低，术前磷水平更高，术后低钙血症发生率更低，住院时间更长。Logistic回归分析显示，术前PTH升高是术前ALP升高的显著独立危险因素（P = 0.000），其值1624 pg/mL为最佳截断点。继发性甲状旁腺功能亢进患者术前ALP升高的预测因素包括术前PTH。对于高危患者，需要更早进行手术、积极补充钙剂以及更仔细或积极的术后护理。
