甲状腺全切术后永久性甲状旁腺功能减退症发生独立危险因素及术后第1天免疫反应性甲状旁腺激素预测价值

目的 探讨甲状腺全切术后永久性甲状旁腺功能减退症（PHPP）发生独立危险因素及术后第1天免疫反应性甲状旁腺激素（iPTH）预测价值。方法 纳入2015年1月至2019年12月于解放军联勤保障部队第九二六医院接受甲状腺全切术治疗病人共273例，根据甲状腺全切术后是否发生PHPP分组，采用单因素和多因素法评价甲状腺全切术后PHPP发生独立危险因素，描绘受试者操作特征曲线（ROC曲线）评价术后第1天iPTH预测价值。结果 PHPP组术后第1天iPTH和血钙水平降低比例分别为72.73%(8/11),63.64%(7/11)，显著高于无PHPP组的36.26%(95/262),35.88%(94/262)(P<0.05)多因素分析结果显示，术后第1天iPTH和血钙水平降低均是甲状腺全切术后PHPP发生独立危险因素（P<0.05）;ROC曲线分析结果显示，术后第1天iPTH水平预测甲状腺全切术后PHPP发生效能高于术后第1天血钙水平（P<0.05）。结论 术后第1天iPTH和血钙水平降低病人在甲状腺全切术后更易发生PHPP，且术后第1天iPTH水平预测效能更高。

Independent risk factors for PHPP after total thyroidectomy and predictive value of iPTH on the first day after operation

Objective To investigate the independent risk factors for PHPP after total thyroidectomy and the predictive value ofiPTH on the first day after operation. Methods A total of 273 patients with total thyroidectomy in 926 Hospital of Joint Logistics Sup-port of the PLA from January 2015 to December 2019 were enrolled. Patients were divided into 2 groups according to the occurence ofPHPP after total thyroidectomy. Univariate and multivariate methods were used to evaluate the independent risk factors for PHPP aftertotal thyroidectomy and ROC curve was drawn to evaluate the predictive value of iPTH on the first day after operation.Results The de-creased proportion of iPTH and serum calcium level on the first day after operation in PHPP group were 72.73% (8/11) and 63.64% (7/11) , respectively, which were significant higher than those of non-PHPP group 36.26%(95/262), 35.88%(94/262) (P<0.05). The resultsof multivariate analysis showed that iPTH and lower serum calcium level on the first day after operation were independent risk factorsfor PHPP after total thyroidectomy (P<0.05). ROC curve analysis showed that iPTH level on the first day after operation was more effec-tive in predicting PHPP than blood calcium level on first day after operation (P<0.05).Conclusion Patients with decreased iPTH and blood calcium levels on the first day after surgery were more likely to develop PHPP after total thyroidectomy, and the iPTH level onthe first day after surgery was more predictive.