Wen Ping, Xu Lingling, Zhao Shasha, Gan Wei, Hou Dawei, Zhang Liang, Cao Jinlong, Xiong Mingxia, Jiang Lei, Yang Junwei
Center for Kidney Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Int J Endocrinol. 2021 Apr 2;2021:6613659. doi: 10.1155/2021/6613659. eCollection 2021.
Hypocalcemia is the most common complication of total parathyroidectomy in secondary hyperparathyroidism (SHPT) and is associated with adverse consequences such as spasms, epilepsy, and arrhythmia and even death if the serum calcium level decreases rapidly. Previous studies have identified several risk factors for postoperative severe hypocalcemia (SH) in patients with SHPT, but the sample sizes were small and thus the results may not be reliable.
This study was performed to investigate the risk factors for SH after total parathyroidectomy without autotransplantation (tPTX) in a large sample of patients with uremic hyperparathyroidism.
We retrospectively investigated the records of 1,095 patients with SHPT treated with tPTX between January 2008 and December 2018. Based on the postoperative serum calcium concentration, the patients were grouped into SH and non-SH groups. The clinical characteristics and biochemical results were analyzed, and binary logistic regression analysis was used to identify the risk factors for SH.
After surgery, 25.9% of the patients developed SH. Age, diastolic blood pressure (DBP), heart rate, frequency of bone pain, weight of resected glands, preoperative serum calcium, intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), and hemoglobin levels differed between the two groups. Binary logistic regression analyses identified preoperative serum calcium, iPTH, and ALP levels as independent predictors of SH after surgery.
The preoperative serum calcium, iPTH, and ALP levels can be used to assess the risk of postoperative SH in patients with SHPT. Such patients should thus be monitored closely in order to initiate prompt interventions to avoid SH.
低钙血症是继发性甲状旁腺功能亢进症（SHPT）患者行甲状旁腺全切除术后最常见的并发症，与痉挛、癫痫、心律失常等不良后果相关，如果血清钙水平迅速下降甚至会导致死亡。既往研究已确定了SHPT患者术后发生严重低钙血症（SH）的若干危险因素，但样本量较小，因此结果可能不可靠。
本研究旨在调查大量尿毒症性甲状旁腺功能亢进症患者行甲状旁腺全切除且未进行自体移植（tPTX）后发生SH的危险因素。
我们回顾性研究了2008年1月至2018年12月期间接受tPTX治疗的1095例SHPT患者的记录。根据术后血清钙浓度，将患者分为SH组和非SH组。分析临床特征和生化结果，并采用二元逻辑回归分析确定SH的危险因素。
术后，25.9%的患者发生SH。两组患者在年龄、舒张压（DBP）、心率、骨痛频率、切除腺体重量、术前血清钙、全段甲状旁腺激素（iPTH）、碱性磷酸酶（ALP）和血红蛋白水平方面存在差异。二元逻辑回归分析确定术前血清钙、iPTH和ALP水平是术后SH的独立预测因素。
术前血清钙、iPTH和ALP水平可用于评估SHPT患者术后发生SH的风险。因此应对此类患者进行密切监测以便及时采取干预措施避免发生SH。
