术中甲状旁腺评分系统的探索及临床意义

发布时间：2018-06-24 18:44

本文选题：甲状腺手术 + 甲状旁腺　；参考：《福建医科大学》2015年硕士论文

【摘要】：目的构建术中甲状旁腺评分系统,初步验证该评分系统与术后甲状旁腺功能减退的关系,并通过该评分系统预测术后甲状旁腺的功能。方法建立术中原位甲状旁腺评分系统及甲状旁腺移植评分系统,回顾性分析2014年07月至2014年12月在我院甲状腺外科同一治疗组接受手术治疗并经病理证实的甲状腺肿瘤患者137例。男性患者22例(16.06%).女性患者115例(83.94%)。患者年龄在18~73岁之间,平均(44.67士12.42)岁。监测术前甲状旁腺激素(parathyroid hormone PTH)、血钙值及术后12-24小时、术后2周的血PTH、血钙值,根据术后2周的血清甲状旁腺激素(PTH2)于术前血清甲状旁腺激素(PTH0)的比值,来评估甲状旁腺的功能受损情况。根据上述的甲状旁腺评分表,最后可以得出经过手术治疗后的甲状旁腺评分差值。采用统计学软件IBM SPSS 19.0对数据进行分析,计数资料采用χ2检验比较分析,计量资料采用t检验,规定P0.05时具有统计学差异。将术后两周的血清甲状旁腺激素与术前的血清甲状旁腺激素的比值(PTH2/PTH0)定为Y轴,把甲状旁腺评分的差值定位X轴,描绘二者的散点图,利用IBM SPSS19.0统计软件对两者进行线性回归分析,规定P0.05时两者线性相关。使用IBM SPSS19.0统计软件的受试者工作特征曲线(receiver operator characteristic curve,ROC曲线)过程。以甲状旁腺评分差值为检验变量(Test Variable),术后2周血清甲状旁腺激素定义甲状旁腺功能减退的结果为状态变量(State Variable),作ROC曲线分析,规定P0.05时具有统计学差异。结果1.甲状腺术后2周的血PTH、血钙与术前的血PTH、血钙进行t检验,有统计学意义(P0.05)。2.术后两周的血清甲状旁腺激素与术前的血清甲状旁腺激素的比值(PTH2/PTH0)与甲状旁腺评分的差值进行线性回归分析,结果提示具有相关性,其中R=0.29,P=0.001。3.ROC曲线的曲线下面积为0.67,当评分差值为8.75分时,敏感度为0.81,特异度为0.57。结论1.甲状腺手术势必会对甲状旁腺的功能产生影响。2.术中甲状旁腺评分系统经过统计学检验,具有统计学意义,对患者术后的甲状旁腺功能状态的预测具有诊断价值。
[Abstract]:Objective to establish an intraoperative parathyroid score system, and to preliminarily verify the relationship between the scoring system and postoperative parathyroid dysfunction, and to predict the function of parathyroid glands after the operation. Methods the orthotopic parathyroid score system and parathyroid transplantation score system were established. A retrospective analysis of the parathyroid parathyroid score system from 07 months to December 2014 2014 was conducted. In the same treatment group, 137 cases of thyroid tumor confirmed by operation and pathology were treated with the same treatment group. 22 cases (16.06%) were male patients and 115 cases (83.94%) of female patients. The patients were aged between 18~73 years, average (44.67, 12.42) years old. Monitoring pre operation parathyroid hormone (parathyroid hormone PTH), blood calcium value and 12-24 hours after operation, Blood PTH, blood calcium, and the ratio of parathyroid hormone (PTH2) to parathyroid parathyroid hormone (PTH0) at 2 weeks after operation to evaluate the function damage of parathyroid glands. According to the above parathyroid score table, the difference of parathyroid parathyroid score after surgical treatment was obtained. Statistical software IBM was used. The data were analyzed by SPSS 19, the count data were compared with the x 2 test, and the measurement data were examined by T, and the statistical difference was stipulated in P0.05. The ratio of serum parathyroid hormone to the preoperative serum parathyroid hormone (PTH2/PTH0) was defined as the Y axis, and the difference between the parathyroid score was defined as the X axis, and the two were depicted by the difference value of the parathyroid parathyroid hormone after the two weeks of operation. Scatter plot, using IBM SPSS19.0 statistical software to analyze both linear regression, and the linear correlation between P0.05 and IBM SPSS19.0 statistics software (receiver operator characteristic curve, ROC curve) process. The parathyroid score difference is the test variable (Test Variable), 2 weeks after the operation The result of parathyroid hormone definition of parathyroid hypogonadism was the state variable (State Variable), the ROC curve was analyzed, and the statistical difference was stipulated in the P0.05. Results 1. the blood PTH, the blood calcium and the preoperative PTH, the blood calcium were tested by T, and the serum parathyroid hormone and the operation two weeks after the operation of P0.05.2. after the operation of the thyroid gland were statistically significant. The difference between the ratio of parathyroid hormone (PTH2/PTH0) and parathyroid score was linear regression analysis. The results suggested that there was a correlation. The area under the curve of R=0.29, P=0.001.3.ROC curve was 0.67, when the score difference was 8.75, the sensitivity was 0.81, and the specificity was 0.57. conclusion 1. thyroid surgery was bound to be side to the side of the thyroid gland. The function of the glands affects the parathyroid scoring system in.2., which is statistically significant, and has a diagnostic value for the prediction of parathyroid function after operation.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R653

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