血浆甲状旁腺激素浓度作为诊断为原发性甲状旁腺功能亢进并接受甲状旁腺切除术的犬术后低钙血症的预测指标。
Plasma Parathyroid Hormone Concentration as a Predictor of Post-Operative Hypocalcemia in Dogs Diagnosed With Primary Hyperparathyroidism and Treated With Parathyroidectomy.
作者信息
Travail Victoria, Motta Claudio, Lea Charlotte, Salas-Garcia Andres, Clarke Katherine, Lombardo Sergio Federico, Paul Amanda, Hajdu Dorothy, Blázquez Carla Asorey, Seth Mayank, Walton-Clark Michelle, Roldan Luis Miguel Garcia, Geddes Rebecca Frances, Conway Sophie Allison, González Katia Sánchez, Domínguez Paula García, Keyte Sophie, Pollard Danica, Kelly Darren
机构信息
Department of Internal Medicine, Southern Counties Veterinary Specialists, Ringwood, Hampshire, UK.
Department of Surgery, Southern Counties Veterinary Specialists, Ringwood, Hampshire, UK.
出版信息
J Vet Intern Med. 2025 Mar-Apr;39(2):e70016. doi: 10.1111/jvim.70016.
BACKGROUND
Hypocalcemia is a relatively common complication after parathyroidectomy for treatment of primary hyperparathyroidism.
OBJECTIVES
To retrospectively evaluate clinical variables in dogs with primary hyperparathyroidism to determine whether or not an association exists between pre-surgical variables and the development of post-surgical hypocalcemia.
ANIMALS
One hundred three dogs diagnosed with primary hyperparathyroidism and treated by parathyroidectomy in seven referral hospitals between 2010 and 2021.
MATERIAL AND METHODS
Data collected from medical records included signalment, physical examination findings, concurrent illnesses, ongoing medications, and clinicopathologic test results (including serum ALP activity, iCa, plasma phosphate and PTH concentrations). Dogs were assigned into groups based on lowest iCa post-surgery: Group1 ≥ 1.1 mmol/L, Group2 < 1.1 mmol/L. The Mann-Whitney U test assessed associations between several variables of interest and the occurrence of post-surgery hypocalcemia. ROC analyses were performed to identify variables that had the potential to predict the development of hypocalcemia after surgery.
RESULTS
The median plasma PTH concentration pre-surgery in dogs which developed hypocalcemia after surgery was significantly higher (232 pg/mL {[IQR] 108-421}) than in dogs which did not develop hypocalcemia after surgery (81.5 pg/mL {IQR 58.5-145.0}; p < 0.001). Plasma PTH concentration had a fair to good ability to predict the development of post-surgery hypocalcemia, with AUC being 0.78 [95% confidence interval 0.67-0.89]. Using a cut-off of ≥ 75 pg/mL, pre-surgery plasma PTH concentration had a sensitivity of 96.6% and specificity of 42.3% for the development of post-surgery hypocalcemia. Dogs that developed hypocalcemia after surgery were older and had lower body weights.
CONCLUSION
Pre-surgery plasma PTH concentrations might be helpful in predicting those dogs at risk of developing hypocalcemia after parathyroidectomy.
背景
低钙血症是甲状旁腺切除术后治疗原发性甲状旁腺功能亢进症相对常见的并发症。
目的
回顾性评估原发性甲状旁腺功能亢进症犬的临床变量，以确定术前变量与术后低钙血症的发生之间是否存在关联。
动物
2010年至2021年期间，在7家转诊医院诊断为原发性甲状旁腺功能亢进症并接受甲状旁腺切除术治疗的103只犬。
材料与方法
从病历中收集的数据包括信号、体格检查结果、并发疾病、正在使用的药物以及临床病理检查结果（包括血清碱性磷酸酶活性、离子钙、血浆磷酸盐和甲状旁腺激素浓度）。根据术后最低离子钙水平将犬分为两组：第1组≥1.1 mmol/L，第2组<1.1 mmol/L。Mann-Whitney U检验评估了几个感兴趣的变量与术后低钙血症发生之间的关联。进行ROC分析以确定有可能预测术后低钙血症发生的变量。
结果
术后发生低钙血症的犬术前血浆甲状旁腺激素浓度中位数（232 pg/mL {[四分位间距] 108 - 421}）显著高于术后未发生低钙血症的犬（81.5 pg/mL {四分位间距58.5 - 145.0}；p < 0.001）。血浆甲状旁腺激素浓度对预测术后低钙血症的发生具有中等至良好的能力，曲线下面积为0.78 [95%置信区间0.67 - 0.89]。使用≥75 pg/mL的临界值，术前血浆甲状旁腺激素浓度对术后低钙血症发生的敏感性为96.6%，特异性为42.3%。术后发生低钙血症的犬年龄较大且体重较低。
结论
术前血浆甲状旁腺激素浓度可能有助于预测甲状旁腺切除术后有发生低钙血症风险的犬。
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