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摘要:
目的 分析行甲状腺全切术且行甲状旁腺自体移植患者的血钙变化规律, 探索自体移植的甲状旁腺功能恢复情况。 方法 回顾性收集并分析2012年4月至2016年1月于北京协和医院行甲状腺全切术且术中行4枚甲状旁腺自体移植患者的临床资料, 利用混合线性模型和Bonfferoni法比较患者术前、术后48 h、1周、1个月、6个月、1年静脉血清总钙水平差异及其变化趋势。 结果 共37例符合纳入和排除标准的患者入选本研究, 其中男性9例, 女性28例, 中位年龄38(33, 46)岁。与术前相比, 患者术后48 h血钙水平显著降低(均值差-0.099 mmol/L, 95% CI:-0.110~-0.088 mmol/L, P < 0.001);术后1周、1个月、6个月、1年的血钙水平均与术前差异均无统计学意义(P均>0.05)。 结论 行4枚甲状旁腺自体移植的患者术后48 h血钙水平显著降低后逐渐回升并能长期维持在正常水平, 提示自体移植的甲状旁腺功能从术后1周开始恢复, 并能长期保持。 Abstract:Objective The aim of this study was to evaluate the rehabilitation time of parathyroid autotransplant through analyzing the changes of blood calcium in total thyroidectomy patients with four parathyroid autotransplanted during surgery. Methods Patients underwent total thyroidectomy with four parathyroid autotransplanted by the same surgeon group at Peking Union Medical College Hospital during the period from April, 2012 to January, 2016 were included. Serum calcium levels at 48 hours, 1 week, 1 month, 6 months and1 year after surgery were collected. The mixed linear model was established and data were analyzed by Bonferroni method after logarithm processing. Results A total of 37 patients who met the inclusion and exclusion criteria were included in this study, including 9 males and 28 females with a median age of 38 (33, 46)years. The levels of Serum calcium significantly decreased 48 hours after thyroidectomy (mean difference -0.099 mmol/L, 95% CI:-0.110~-0.088 mmol/L, P < 0.001). There was no significant difference in the levels of serum calcium at 1 week, 1 month, 6 months and 1 year after surgery (all P>0.05). Conclusions The levels of serum calcium of the 4 patients with parathyroid gland autotransplantation decreased significantly 48 h after surgery and then gradually recovered and maintained at the normal level for a long time, which suggests that the autotransplanted parathyroid begins to recover 1 week after surgery and can be maintained for a long time. -
Key words:
- thyroidectomy /
- hypoparathyroidism /
- parathyroid autotransplantation /
- hypocalcemia
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表 1 患者不同时间点血钙水平比较(mmol/L)
时间 例数*(n) 几何均数 均值差(95% CI) P值 术前 37 2.28 - - 术后48 h 37 1.82 -0.099(-0.110~-0.088) ＜0.001 术后1周 35 2.23 -0.009(-0.024~0.005) 0.467 术后1个月 29 2.27 -0.001(-0.012~0.009) ＞0.999 术后6个月 34 2.28 -0.003(-0.012~0.006) ＞0.999 术后1年 33 2.27 -0.004(-0.012~0.003) 0.606 *因部分患者在某些时间点未随诊(血钙数据缺失)，导致不同时间点的患者例数不同 
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