继发性甲状旁腺功能亢进患者甲状旁腺切除术后短期钙磷变化的观察与分析

目的探讨继发性甲状旁腺功能亢进(SHPT)患者行甲状旁腺切除术(PTX)后短期钙磷变化情况并分析其相关因素。方法回顾性分析于我院行PTX的难治性SHPT患者18例,收集所有患者术前的基线资料和术后第1天、第3天及第7天的血全段甲状旁腺激素(iPTH)、血碱性磷酸酶(ALP)、血钙、血磷等生化指标并进行比较,统计所有患者术后1周的补钙量。采用Pearson和Spearman相关分析研究患者术前血iPTH、血钙、血磷、血ALP水平及术后1周补钙总量的相关性。结果术后第1天、第3天和第7天患者血iPTH和血磷与术前比较均明显下降(P均<0.05);术后第1天血ALP与术前比较明显下降(P<0.05);术后第7天血钙与术前比较明显下降(P<0.05)。术前血iPTH水平与术前血ALP水平呈正相关(r=0.773,P<0.001),术后1周补钙量与术前血iPTH水平(r=0.855,P<0.001)、术前血ALP水平(r=0.925,P<0.001)均呈正相关。结论PTX治疗难治性SHPT安全有效,能在短期内快速纠正血钙、血磷的代谢紊乱。

Analysis of short-term changes of calcium and phosphorus in secondary hyperparathyroidism patients after the treatment of parathyroidectomy

Objective To explore the short-term variation and related factors of serum calcium and phosphorus after parathyroidectomy(PTX) in patients with secondary hyperparathyroidism (SHPT).Methods A total of 18 patients treated with PTX for intractable SHPT in our hospital were analyzed retrospectively.Baseline data and serum intact parathyroid hormone(iPTH),serum alkaline phosphatase(ALP),serum calcium and phosphorus of all patients on the first，the third and the seventh day after PTX were collected and compared.The calcium requirements in a week after PTX were collected.Pearson and Spearman correlation analysis were used to analyze the correlation among preoperative serum iPTH,serum calcium,serum phosphorus,serum ALP and calcium requirements in a week after the operation.Results Serum iPTH and phosphorus of all patients on the first，the third and the seventh day after PTX were significantly decreased than those before PTX(P＜0.05).Serum ALP on the first day after PTX was significantly decreased than that before PTX(P＜0.05).Serum calcium on the seventh day after PTX was significantly decreased than that before PTX(P＜0.05).Serum iPTH level before PTX was positively correlated with serum ALP level before PTX(r=0.773,P＜0.001).Calcium requirements in a week after PTX were positively correlated with serum iPTH level(r=0.855,P＜0.001) and ALP level(r=0.925,P＜0.001)before PTX.Conclusion PTX is a safe and effective treatment for intractable SHPT，which can quickly correct the metabolic disorder of serum calcium and phosphorus in short time.