甲状腺手术后甲状旁腺功能减退症的定义和诊断：荟萃分析。
Definition and diagnosis of postsurgical hypoparathyroidism after thyroid surgery: meta-analysis.
机构信息
Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany.
Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany.
出版信息
BJS Open. 2022 Sep 2;6(5). doi: 10.1093/bjsopen/zrac102.
BACKGROUND
Postsurgical hypoparathyroidism (PH) is the most frequent complication after thyroid surgery. The aim of this systematic review and meta-analysis is to summarize a unifying definition of PH and to elucidate the best possible approach for early detection of PH.
METHODS
A systematic review of the literature according to the PICO framework using Embase, PUBMED and the Cochrane library was carried out on 1 December 2021 followed by analysis for risk of bias, data extraction and meta-analysis. All studies addressing the definition of postoperative hypoparathyroidism and/or diagnostic approaches for early detection and diagnosis were included. Case reports, commentaries, non-English articles, book chapters and pilot studies and reviews were excluded.
RESULTS
From 13 704 articles, 188 articles were eligible for inclusion and further analysis. These articles provided heterogeneous definitions of PH. Meta-analysis revealed that postoperative measurements of parathormone (PTH) levels have a higher sensitivity and specificity than intraoperative PTH measurements to predict PH after thyroid surgery. None of the timeframes analysed after surgery within the first postoperative day (POD1) was superior to predict the onset of PH. PTH levels of less than 15 pg/ml and less than 10 pg/ml are both reliable threshold levels to predict the postoperative onset of PH. A relative reduction of mean(s.d.) PTH levels from pre- to postoperative values of 73 (standard deviation 11) per cent may also be predictive for the development of PH. The estimation of calcium levels on POD1 are recommended.
CONCLUSION
PH is best defined as an undetectable or inappropriately low postoperative PTH level in the context of hypocalcaemia with or without hypocalcaemic symptoms. PTH levels should be measured after surgery within 24 h. Both threshold levels below 10 and 15 pg/ml or relative loss of PTH before/after thyroid surgery are reliable to predict the onset of PH.
背景
手术后甲状旁腺功能减退症（PH）是甲状腺手术后最常见的并发症。本系统评价和荟萃分析的目的是总结 PH 的统一定义，并阐明早期发现 PH 的最佳方法。
方法
根据 PICO 框架，于 2021 年 12 月 1 日对 Embase、PUBMED 和 Cochrane 图书馆的文献进行系统评价，然后进行偏倚风险分析、数据提取和荟萃分析。所有涉及术后甲状旁腺功能减退症定义和/或早期检测和诊断诊断方法的研究均包括在内。排除病例报告、评论、非英语文章、章节和试点研究和综述。
结果
从 13704 篇文章中，有 188 篇文章符合纳入和进一步分析的条件。这些文章对 PH 的定义存在异质性。荟萃分析显示，术后甲状旁腺激素（PTH）水平的测量比术中 PTH 测量更能预测甲状腺手术后 PH 的发生，具有更高的敏感性和特异性。手术后第一天（POD1）内分析的任何时间段都不能更好地预测 PH 的发生。PTH 水平低于 15pg/ml 和低于 10pg/ml 都是预测术后 PH 发生的可靠阈值水平。从术前到术后的平均（标准差）PTH 水平降低 73%（标准差 11%）也可能是 PH 发展的预测指标。建议在 POD1 时估计钙水平。
结论
PH 最好定义为在伴有或不伴有低钙血症的低钙血症的情况下，术后无法检测到或检测到的 PTH 水平过低。应在手术后 24 小时内测量 PTH 水平。阈值水平低于 10 和 15pg/ml 或甲状腺手术后前后 PTH 的相对损失均可靠，可预测 PH 的发生。
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