Liu Xiao, Li Weiqian, Huang Chuancheng, Li Zongyu
Department of Basic Medical Sciences, The 960th Hospital of PLA, No. 25 Shifan Road, Tianqiao District, Jinan, 250031, Shandong, China.
Department of Orthopedics, The 960th Hospital of PLA, No. 25 Shifan Road, Tianqiao District, Jinan, 250031, Shandong, China.
J Endocrinol Invest. 2025 Feb;48(2):369-380. doi: 10.1007/s40618-024-02460-w. Epub 2024 Oct 3.
To analyze the risk factors associated with the development of severe hypocalcemia (SH) in patients who have undergone parathyroidectomy (PTX).
This research involved patients with chronic kidney disease-secondary hyperparathyroidism who underwent PTX between June 1, 2021, and May 31, 2023. SH was characterized by a serum total calcium (tCa) level below 1.8 mmol/L. This study aimed to analyze differences in preoperative laboratory findings and clinical manifestations between patients with and without SH. Logistic regression analysis was used to identify potential risk factors associated with the development of SH.
The incidence of SH was 23% (n = 176). Significant differences were observed in free thyroxine (FT4), free triiodothyronine, alanine aminotransferase, osteocalcin, tCa, alkaline phosphatase (ALP), C-terminal cross-linked telopeptide of type I collagen, and parathyroid hormone between the SH and non-SH groups. The three independent risk factors for SH were tCa [odds ratio (OR) 0.063, 95% confidence interval (95% CI) 0.006-0.663], ALP (OR 1.003, 95% CI 1.001-1.005), and FT4 (OR 0.439, 95%CI 0.310-0.621). The area under the curve, sensitivity, specificity, and overall accuracy of this model were 0.904 (95% CI 0.856-0.952), 46.3%(95% CI 32.0%-61.3%), 94.8% (95% CI 89.7%-97.5%), and 83.5% (95% CI 77.3%-88.3%), respectively.
The preoperative level of FT4 plays a crucial role in predicting the risk of SH after PTX. The combined FT4-ALP-tCa model demonstrates the ability to predict SH risk, providing valuable insights for customizing calcium supplementation strategies and improving clinical decision-making.
分析甲状旁腺切除术后患者发生严重低钙血症（SH）的相关危险因素。
本研究纳入了2021年6月1日至2023年5月31日期间接受甲状旁腺切除术的慢性肾脏病继发性甲状旁腺功能亢进患者。SH的特征为血清总钙（tCa）水平低于1.8 mmol/L。本研究旨在分析发生和未发生SH的患者术前实验室检查结果及临床表现的差异。采用逻辑回归分析确定与SH发生相关的潜在危险因素。
SH的发生率为23%（n = 176）。SH组和非SH组在游离甲状腺素（FT4）、游离三碘甲状腺原氨酸、丙氨酸转氨酶、骨钙素、tCa、碱性磷酸酶（ALP）、I型胶原C端交联肽和甲状旁腺激素方面存在显著差异。SH的三个独立危险因素为tCa[比值比（OR）0.063，95%置信区间（95%CI）0.006 - 0.663]、ALP（OR 1.003，95%CI 1.001 - 1.005）和FT4（OR 0.439，95%CI 0.310 - 0.621）。该模型的曲线下面积、灵敏度、特异度和总体准确率分别为0.904（95%CI 0.856 - 0.952）、46.3%（95%CI 32.0% - 61.3%）、94.8%（95%CI 89.7% - 97.5%）和83.5%（95%CI 77.3% - 88.3%）。
术前FT4水平在预测甲状旁腺切除术后SH风险中起关键作用。FT4 - ALP - tCa联合模型显示出预测SH风险的能力，为定制补钙策略和改善临床决策提供了有价值的见解。
