继发性甲状旁腺功能亢进症行甲状旁腺全切除术后低钙血症危险因素分析OA

Objective To investigate the risk factors of hypocalcemia in patients with secondary hyperparathyroidism(SHPT)after total parathyroidectomy(TPTX),and to provide supplementary recommendations for postoperative calcium management strategies in current guidelines based on long-term follow-up data.Methods Clinical data of 190 SHPT patients who underwent total parathyroidectomy at China-Japan Friendship Hospital from April 2012 to August 2015 were retrospectively analyzed.Perioperative biochemical indicators were analyzed,independent risk factors for postoperative hypocalcemia were screened by multivariate Logistic regression,and a long-term follow-up for an average of 7 years was conducted.Results Among the 152 patients who underwent successful TPTX,118(77.6%)developed postoperative hypocalcemia.Univariate analysis indicated that patients in the hypocalcemia group were younger and presented with higher preoperative levels of parathyroid hormone and alkaline phosphatase(ALP),along with lower preoperative serum calcium.Multivariate retrospective analysis revealed that a high preoperative ALP level was the strongest independent risk factor for postoperative hypocalcemia(OR=0.9881,P=0.0006).By the final follow-up in August 2021,with an average duration of 7 years,data showed that following standardized treatment,the mean serum calcium level reached(2.22±0.24)mmol/L,effectively returning to the normal range.Conclusion Preoperative high ALP level is a key indicator for predicting severe hungry bone syndrome and hypocalcemia after TPTX.Clinical practitioners should perform risk stratification based on preoperative ALP levels and implement an intensified supplementation strategy of combined calcium and active vitamin D for high-risk patients,which is beyond current guidelines.