Predictive value of PTH level on day 1 after surgery for papillary thyroid carcinoma in patients with permanent hypoparathyroidism
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摘要: 目的 探讨甲状腺乳头状癌(papillary thyroid carcinoma，PTC)根治术后第1天甲状旁腺激素(parathyroid hormone，PTH)水平与永久性甲状旁腺功能减退(permanent hypoparathyroidism，PHPP)之间的关系及预测价值。方法 收集并分析甘肃省人民医院普外科2021年1月—2022年1月收治的行甲状腺全切及中央区淋巴结清扫的PTC患者80例。根据术后是否发生PHPP将患者分为甲状旁腺功能减退组和甲状旁腺功能正常组，采用单因素及二元logistics回归对两组患者术后第1天甲状旁腺激素PTH和血清钙离子水平与PHPP的相关性进行分析；对患者术后不同时间点PTH的动态变化情况进行分析；采用受试者工作曲线下面积评估PTH对术后发生PHPP的预测效力。结果 在纳入的80例PTC患者中有10例发生PHPP，发生率为12.5%；二元logistics回归分析显示，术后第1天PTH(OR=14.534，95%CI：2.377~88.858，P=0.004)，是术后发生PHPP的独立性预测危险因素。以术后第1天PTH=8.75 ng/L为临界值，曲线下面积为0.874(95%CI：0.790~0.958，P＜0.001)，灵敏度为71.4%，特异度为100%，约登指数为0.714。结论 PTC全切术后第1天PTH水平与PHPP密切相关，也是发生PHPP的独立性预测危险因素。
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关键词:
- 甲状旁腺激素 /
- 甲状腺癌根治术 /
- 永久性甲状旁腺功能减退
Abstract: Objective To investigate the relationship between parathyroid hormone(PTH) level and permanent hypoparathyroidism(PHPP) on the first day after radical papillary thyroidectomy, and its predictive value.Methods A total of 80 patients with papillary thyroid cancer who underwent total thyroid resection and central lymph node dissection were collected and analyzed from January 2021 to January 2022. According to whether PHPP occurred after surgery, the patients were divided into hypoparathyroidism group and normal parathyroid function group, and univariate and binary logistics regression were used to analyze the correlation between PTH and serum calcium levels and PHPP on the first day after surgery in two groups. The dynamic changes of PTH at different time points after operation were analyzed. The area under the receiver operating characteristic was used to evaluate the predictive power of PTH on the development of PHPP after surgery.Results Among the 80 patients with papillary thyroid cancer, 10 cases developed PHPP, with an incidence rate of 12.5%. Binary logistics regression analysis showed that PTH on the first postoperative day(OR=14.534, 95%CI: 2.377-88.858, P=0.004) was an independent predictive risk factor for postoperative PHPP. Taking PTH=8.75 ng/L on the first postoperative day as the cut-off value, the AUC of the area under the curve was 0.874(95%CI: 0.790-0.958, P < 0.001), the sensitivity was 71.4%, the specificity was 100%, and the Yoden index was 0.714.Conclusion PTH level on the first day after total thyroid papillary carcinoma surgery is closely related to PHPP, and is an independent predictor of PHPP. -
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表 1 术后6个月发生PHPP的单因素分析
例(%) 项目 PHPP组(n=10) 正常组(n=70) χ2 P 性别/例 男∶女 4∶6 22∶48 0.033 0.857 年龄/岁 1.616 0.204 < 55 7(70.00) 42(60.00) ≥55 3(30.00) 28(40.00) 合并疾病 高血压 7(70.00) 30(42.86) 1.616 0.204 心脏病 2(20.00) 25(35.71) 0.391 0.532 糖尿病 4(40.00) 18(25.71) 0.322 0.570 肿瘤大小/cm 0.588 0.443 < 2 6(60.00) 29(41.43) ≥2 4(40.00) 41(58.57) 术后1 d PTH 19.175 0.001 正常 0(0) 53(75.71) 减低 10(100.00) 17(24.29) 术后1 d血钙 4.535 0.033 正常 2(20.00) 43(61.43) 减低 8(80.00) 27(38.57) 
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表 2 术后6个月发生PHPP多因素分析
项目 β 标准误 Wald P OR 95%CI 性别 -0.692 1.072 0.416 0.519 0.501 0.061~4.092 年龄 -0.917 0.895 1.050 0.306 0.400 0.069~2.311 肿瘤是否>2 cm -0.571 0.848 0.454 0.500 0.565 0.107~2.977 合并疾病 高血压 1.204 0.918 1.722 0.189 3.333 0.552~20.131 心脏病 -1.318 1.072 1.509 0.219 0.268 0.033~2.191 糖尿病 1.309 0.984 1.770 0.183 3.702 0.538~25.466 术后1 d PTH水平 2.677 0.924 8.395 0.004 14.534 2.377~88.858 术后1 d血钙水平 0.885 1.073 0.679 0.410 2.422 0.295~19.860
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