Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Department of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Nephrology (Carlton). 2021 May;26(5):408-419. doi: 10.1111/nep.13854. Epub 2021 Feb 12.
Severe hypocalcaemia following parathyroidectomy for secondary or tertiary hyperparathyroidism (SHPT/THPT) is scarcely studied. We aimed to describe and identify risk factors for early and persistent hypocalcaemia after parathyroidectomy.
Retrospective pair-matched cohort study. We assessed 87 dialysis patients with SHPT (n = 73) or THPT (n = 14) paired with 146 subjects with primary hyperparathyroidism (PHPT) who underwent parathyroidectomy and were followed for 12 months. Early severe hypocalcaemia was defined as a free Ca ≤0.8 mmol/L [3.2 mg/dl] or corrected Ca ≤1.87 mmol/L [7.5 mg/dl] within 48 h. After parathyroidectomy and persistent hypocalcaemia, as an elemental Ca intake >3.0 g/day to achieve corrected Ca >2 mmol/L [8.0 mg/dl].
Early severe hypocalcaemia occurred in 77% (67/87) versus 6.8% (10/146) of subjects with SHPT/THPT and PHPT, respectively (p < .001). In SHPT/THPT cases, persistent hypocalcaemia occurred in 77% (49/64) and 64% (35/54) after 6 and 12 months of parathyroidectomy, respectively. In PHPT cases, persistent hypocalcaemia occurred in 6.8% (10/146) after 4-12 months of parathyroidectomy. Preoperative serum alkaline phosphatase (ALP) was the only risk factor associated to early severe hypocalcaemia (OR 7.3, 95% C.I. 1.7-10.9, p = .006) and persistent hypocalcaemia (OR 7.1, 95% C.I: 2.1-14.2, p = .011). Subjects with persistently low intact parathormone (iPTH) (<5.3 pmol/L [50 ng/ml]), suggestive of adynamic bone disease) showed higher Ca increases and less oral calcium requirements compared to those who progressively increased iPTH after parathyroidectomy.
Early and persistent hypocalcaemia after parathyroidectomy in severe HPT were a common event associated directly to preoperative ALP levels. Subjects with persistently low postoperative iPTH normalized serum Ca more frequently after 1 year of follow up.
甲状旁腺切除术治疗继发性或三发性甲状旁腺功能亢进症（SHPT/THPT）后严重低钙血症鲜有研究。我们旨在描述和确定甲状旁腺切除术后早期和持续低钙血症的危险因素。
回顾性配对队列研究。我们评估了 87 例 SHPT（n=73）或 THPT（n=14）透析患者与 146 例接受甲状旁腺切除术的原发性甲状旁腺功能亢进症（PHPT）患者配对，随访 12 个月。早期严重低钙血症定义为游离钙≤0.8mmol/L[3.2mg/dl]或校正钙≤1.87mmol/L[7.5mg/dl]在 48 小时内。甲状旁腺切除术后，持续低钙血症是指元素钙摄入量>3.0g/天，以达到校正钙>2mmol/L[8.0mg/dl]。
SHPT/THPT 组和 PHPT 组分别有 77%（67/87）和 6.8%（10/146）的患者出现早期严重低钙血症（p<0.001）。在 SHPT/THPT 患者中，甲状旁腺切除术后 6 个月和 12 个月时分别有 77%（49/64）和 64%（35/54）的患者出现持续性低钙血症。PHPT 患者中，甲状旁腺切除术后 4-12 个月时，持续性低钙血症的发生率为 6.8%（10/146）。术前血清碱性磷酸酶（ALP）是唯一与早期严重低钙血症（OR7.3，95%CI1.7-10.9，p=0.006）和持续性低钙血症（OR7.1，95%CI：2.1-14.2，p=0.011）相关的危险因素。持续低水平完整甲状旁腺激素（iPTH）（<5.3pmol/L[50ng/ml]，提示无动力性骨病）的患者，与甲状旁腺切除术后 iPTH 逐渐升高的患者相比，血清 Ca 升高更多，口服钙需求更少。
严重 HPT 患者甲状旁腺切除术后早期和持续低钙血症是一种常见事件，与术前 ALP 水平直接相关。术后持续低 iPTH 的患者在随访 1 年后更常使血清 Ca 正常化。
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