| Objective:To study on influence factors of blood calcium decline after surgery for primary hyperparathyroidism,to predict and analyze the extent of blood calcium decline after surgery,to provide a reference for the development of effective calcium supplement strategy after surgery,reduce the incidence of transitory or persistent hypocalcemia.Methods:The retrospective study on 118 patients with primary hyperparathyroidism by the surgical treatment in the department from June 2008 to December 2017.Analyze the detailed medical history and biochemical indicators including the patients' gender,age,blood calcium,body mass index(BMI),thyroid stimulating hormone(TSH),blood phosphorus,alkaline phosphatase(ALP),parathyroid hormone(PTH),calcitonin and the volume of lesioned parathyroid glands.The group standard according to the guideline of the Diagnosis and Treatment of Hypercalcemia [1],118 patients were divided into normal blood calcium group,mild hypercalcemia group,moderate hypercalcemia group,severe hypercalcemia group;analyse the factors affecting postoperative blood calcium decline in each group by single factor analysis and multivariate analysis;ROC curve was made for the influence factors in the normal blood calcium group and the mild hypercalcemia group.To explore the factors that influence the changes of postoperative blood calcium in patients.Results:1.Clinical features:Basic situation: There were 28 males(23.7%),90 females(76.3%),and males:females 1:3.2.The age of the patients was 50.57±10.22 years.Postoperative paraffin pathology was parathyroid adenoma in all patients.The blood calcium of all patients was 2.94±0.36mmol/L.The blood calcium before surgery was 2.89±0.33mmol/L.The blood calcium after surgery was 2.40±0.31mmol/L.The BMI of patients was 23.34±3.60;the TSH was 2.54±1.04mIU/L;the blood phosphorus before surgery was 0.87 ± 0.47mmol/L;the value of alkaline phosphatase was 243.21 ±42.92IU/L.The preoperative PTH was 636.63 ± 68.68pg/ml;the postoperative PTH was 55.85±6.47pg/ml and the PTH rate was 86.89±12.90%;the calcitonin was 0.96±0.19pg/ml.The average volume of lesioned parathyroid glands was 7.11±1.22cm3.Initial blood calcium groups: The patients were divided into 4 groups according to the initial blood calcium values: 34 patients(28.8%)in the normal blood calcium group,40 patients(33.9%)in the mild hypercalcemia group,and 32 patients in the moderate hypercalcemia group(27.1 %),12 patients(10.2%)in the severe hypercalcemia group.Postoperative blood calcium: Among 118 patients,normal postoperative blood calcium was 88 cases(74.6%)and postoperative hypocalcemia was 30 cases(25.4%).In the normal blood calcium group: normal postoperative blood calcium was 21 cases(61.8%)and postoperative hypocalcemia was 13 cases(38.2%).In the mild hypercalcemia group: 25 cases(62.5%)had normal blood calcium after surgery,and 15 cases(37.5%)had hypocalcemia after surgery.In the moderate hypercalcemia group,30 patients(93.8%)had normal blood calcium after surgery,and 2 patients(6.2%)had hypocalcemia after surgery.In the severe hypercalcemia group,12 cases(100%)had normal blood calcium after surgery,and no patients had hypocalcemia after surgery.2.Normal blood calcium group influence factors: Initial blood calcium(r = 0.475,P = 0.005),preoperative blood calcium(r = 0.409,P = 0.016)were positively correlated with postoperative blood calcium decline.Postoperative PTH(r=-0.447,P=0.029)was inversely associated with postoperative blood calcium decline.Postoperative PTH(P=0.011)was an independent influence factor affecting postoperative blood calcium decline in this group of patients.3.Mild hypercalcemia group influence factors: Preoperative PTH(r=0.340,P=0.032)and PTH decline rate(r=0.369,P=0.027)were positively correlated with postoperative blood calcium decline.ROC curve showed that when preoperative PTH=193.95pg/ml,AUC=0.733 > 0.7,P =0.018 < 0.05,which was of statistical significance and had a good diagnostic value for postoperative hypocalcemia.4.Moderate hypercalcemia group influence factors: Age(r =-0.389,P = 0.028),TSH(r =-0.473,P = 0.017)were negatively correlated with postoperative blood calcium decline.Initial blood calcium(r=0.423,P=0.016)was positively correlated with postoperative blood calcium decline.Age was an independent influence factor for postoperative blood calcium decline in this group.5.Severe hypercalcemia group influence factors: BMI(r=-0.767,P=0.016)was negatively correlated with postoperative blood calcium decline.Conclusion:1.For primary hyperparathyroidism with normal initial blood calcium,influence factors are initial blood calcium,preoperative blood calcium and postoperative PTH.Among them,postoperative PTH is an independent factor affecting postoperative calcium decline in such patients,the lower postoperative PTH,the more significant the postoperative calcium decline.2.For primary hyperparathyroidism with mild hypercalcemia,the main factors affecting the degree of postoperative blood calcium decline are the preoperative PTH and PTH decline rate.The higher the preoperative PTH,the more significant the postoperative blood calcium declined.The higher the PTH decline rate,the more significant the postoperative blood calcium declined.When the preoperative PTH was greater than 193.95pg/ml,postoperative hypocalcemia was likely to occur.3.For primary hyperparathyroidism with moderate hypercalcemia,age,TSH and initial blood calcium were the main influence factors for postoperative blood calcium decline.Age was the independent factor of postoperative blood calcium decline in these patients,and the younger age,the higher the incidence of postoperative hypocalcemia.4.For primary hyperparathyroidism with severe hypercalcemia,the influence factor of postoperative blood calcium decline was the patients' BMI,which presented a negative correlation. |
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