| 闻 萍,侯大卫,曹金龙,骆 静,王忠霞,汤 兵,江 蕾.术后血清PTH下降率预测甲状旁腺全切术后复发的临床价值[J].,2017,17(29):5650-5653 |
| 术后血清PTH下降率预测甲状旁腺全切术后复发的临床价值 |
| Clinical Value of PTH Monitoring for the Prediction of Recurrence after Parathyroidectomy |
| 投稿时间：2017-05-02 修订日期：2017-05-25 |
| DOI：10.13241/j.cnki.pmb.2017.29.011 |
| 中文关键词: 甲状旁腺切除术 甲状旁腺激素 甲状旁腺激素下降率 |
| 英文关键词: PTX PTH PTH reduction rate |
| 基金项目:国家自然科学基金项目（31300955）；江苏省自然科学基金面上项目（BK20141489） |
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| 中文摘要: |
| 摘要 目的：探讨甲状旁腺全切术后PTH的监测对于预测手术后是否复发的临床价值，确定具有预测价值的术后PTH的监测时间以及下降率。方法：选取本中心2009年5月至2014年8月收治的338例继发性甲状旁腺机能亢进症(secondary hyperparathyroidism，SHPT)患者作为研究对象，所有患者手术方式均为甲状旁腺全部切除术(total parathyroidectomy，t-PTX)。分别在手术前、术后1小时、术后24小时采集患者的血液标本检测血清PTH水平，并随访至术后一年，观察PTH的下降率与复发的相关性。结果：338名例患者术前、术后1小时和术后24小时的血清PTH水平分别是(1623.2±903.2 pg/mL)、(63.4±80.8 pg/mL)、(20.9±97.0 pg/mL)。所有患者术后1小时和术后24小时PTH下降率均大于50%，平均值分别为95.9±5.1%和98.8±4.8%。未复发组术后1小时PTH的下降率中位数为97.1%(63.6-99.9%)，复发组术后1小时PTH下降率中位数为79.6%(48.0-96.7%)，两组间术后1小时和术后24小时PTH下降率比较差异具有统计学意义(P<0.01)。术后1小时及术后24小时PTH下降率的受试者工作特征曲线显示曲线下面积分别为0.907和0.897(P值均<0.001)。当PTH下降率为90%时，诊断手术成功的敏感性为87.23%，特异性为88.89%。且术后1小时和术后24小时的PTH 下降率基本一致，对于术后复发的临床价值无统计学差异。结论：甲状旁腺全切术后1小时血清PTH的下降率预测术后复发与术后24小时血清PTH的下降率预测手术复发的临床价值相当。 |
| 英文摘要: |
| ABSTRACT Objective: The study is aimed to explore the clinical value of PTH monitoring for the prediction of recurrence after parathyroidectomy, to determine the time to monitor and the rate of PTH reduction. Methods: 338 SHPT patients undergo PTX operation from our kidney center between May 2009 to August 2014 are included in our study, all of the patients experienced total parathyroidectomy (t-PTX). Blood samples were collected before operation, at 1 h, 24 h and 1 year after operation to detect the PTH level. The correlation of rate of PTH reduction and recurrence was analyzed. Results: The mean levels of PTH before operation, at 1 h, 24 h after operation were (1623.2±903.2 pg/mL), (63.4±80.8 pg/mL) and (20.9±97.0 pg/mL) respectively. All of the PTH reduction rate at 1 hour and 24 h after operation were more than 50%, which were 95.9±5.1% and 98.8±4.8% respectively. The median of PTH reduction rate at 1h after op- eration of the cure group was 97.1%(63.6-99.9%) and 79.6%(48.0-96.7%) in the recurrence group. There was significant difference be- tween the two groups (P<0.01). The AUC of receiver operating characteristic curve (ROC) of PTH reduction rate at 1 hour and 24 h after operation was 0.90 and 0.897 respectively (P<0.001). When PTH reduction rate was 90%, the diagnostic sensitivity and specificity were 87.23% and 88.89% respectively. Conclusion: The PTH reduction rate after the PTX could be used to predict the recurrence of the oper- ation, and the clinical value of PTH reduction rate at 1 hour and 24 h after PTX for recurrence was equal. |
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