分化型甲状腺癌围手术期甲状旁腺功能监测与基于危险分层的个体化预防性补钙策略探讨

发布时间：2018-01-12 23:17

本文关键词：分化型甲状腺癌围手术期甲状旁腺功能监测与基于危险分层的个体化预防性补钙策略探讨　出处：《广西医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：分析低钙血症潜在危险因素对分化型甲状腺癌(differentiated thyroid carcinoma, DTC)术后各阶段甲状旁腺激素(parathyroid hormone, PTH)与血钙的影响。探讨以不同危险分层为依据的对DTC患者术后有效的预防性补钙策略,为分层个体化预防性补钙提供临床证据支持。方法：对2015年3月至2016年2月期间诊治的117例DTC患者进行前瞻性研究。按危险分层评分高低将其分为低危组(A组)及高危组(B组及C组)。其中A组不予补钙,B组予以静脉补钙2g qd,C组予以静脉补钙2g bid,对各组低钙症状及低钙血症发生率进行比较。监测围手术期第0至第4阶段(术前、术后1-3天、术后4-6天、术后第7天、术后第14天后)血PTH及血钙水平,分析性别、甲状腺处理方式、中央区淋巴结清扫范围、甲状旁腺自体移植数以及钙剂支持对血PTH及血钙的影响。结果：血PTH水平在第1阶段下降至最低点,其后逐渐上升,在第4阶段仍低于术前水平。第2阶段血钙水平数值最低,但各阶段间差异无统计学意义。0阶段女性PTH水平高于男性(46.75±17.3 pg/ml VS 38.08±14.78 pg/mlχ2=5.518, P=0.02)。行甲状腺腺叶及峡叶切除(unilateral lobectomy plus isthmectomy, ULI)患者第1-3阶段血PTH及血钙明显高于甲状腺全切(totalthyroidectomy, TT)忠者(P0.01)。双侧中央区淋巴结清扫(bilateral central neck dissection, BCND)组血PTH明显低于单侧中央区淋巴结清扫(unilateral central neck dissection, UCND)组(χ2=-4.83,P0.05),尤其在第1-3阶段(P0.01),但两组间血钙水平无显著差异。甲状旁腺白体移植(parathyroid autotransplantation, PAT)2枚组血PTH及血钙较PAT 1枚组和未移植组低,而PAT 1枚组和未移植组间差异无统计学意义。A组术后各阶段血PTH均高于其余两组, B组与C组之间则无统计学差异(P=0.28)。三组中B组低钙血症发生率最高,其次为C组,A组最低(47.9%； 31.2%；17.2%P0.05)。B组低钙症状发生率(25.5%)高于其余两组,A、C组间发生率无统计学差异(4.1%；5.2%P=0.65)。症状组血钙值95%置信区间CI[1.74,1.80]。结论：①围手术期血PTH经历先降后升的过程,最低水平出现在术后1-3天,但恢复至术前水平需要2周以上。②女性血PTH基础水平高于男性。③较之于ULI及UCND,TT及BCND更易导致较低的PTH水平。④TT更易导致患者出现低钙血症。⑤2枚甲状旁腺自体移植对于DTC术后血PTH及血钙水平无显著影响。⑥予以低钙血症高危患者2g bid静脉输注10%葡萄糖酸钙有利于减少低钙症状的发生率,并且维持适宜的血钙水平。⑦当血钙1.8mmol/L时应高度警惕低钙症状的发生。
[Abstract]:Objective: to analyze the potential risk factors of hypocalcemia for differentiated thyroid carcinoma in differentiated thyroid carcinoma. After operation, parathyroid hormone was used in all stages. To explore effective preventive calcium supplementation strategies based on different risk stratification for DTC patients. To provide clinical evidence for individualized and stratified prophylactic calcium supplementation. Methods:. A prospective study was conducted in 117 patients with DTC from March 2015 to February 2016. The patients were divided into low risk group according to their risk stratification scores (P < 0.05). Group A) and high risk group, group B and group C. among them, group A did not receive calcium supplementation. Group B was given 2g QDX by intravenous calcium supplementation. The incidence of hypocalcemia and hypocalcemia were compared. The perioperative stages 0 to 4 (preoperative) were monitored. Serum PTH and calcium levels, sex, thyroid management, and the extent of central lymph node dissection were analyzed 1-3 days, 4-6 days, 7 days and 14 days after operation. Effect of autotransplantation of parathyroid gland and calcium on blood PTH and calcium. Results: the level of serum PTH decreased to its lowest level in stage 1 and then increased gradually. The level of serum calcium in stage 4 was still lower than that before operation, and the level of serum calcium in stage 2 was the lowest. However, there was no significant difference between different stages. The level of PTH in females was higher than that in males at stage 0 (P < 0.05). 46.75 卤17.3 pg/ml vs 38.08 卤14.78 pg/ml 蠂 2 5.518. The thyroid gland lobe and isthmus lobectomy were performed with unilateral lobectomy plus isthmectomy. The levels of serum PTH and serum calcium in patients with uli were significantly higher than those in total thyroidectomy. The bilateral central neck dissection were dissected in bilateral central area. The serum PTH in BCND group was significantly lower than that in unilateral central neck dissection. UCND group (蠂 ~ 2 ~ (-4.83) P _ (0.05) P ~ (0.05)), especially in stage 1-3 (P _ (0.01)). But there was no significant difference in serum calcium level between the two groups. Parathyroid autotransplantation was transplanted into parathyroid white body. The levels of PTH and calcium in PAT)2 group were lower than those in PAT group and untransplanted group. There was no significant difference between the PAT group and the untransplanted group. The blood PTH in group A was higher than that in the other two groups. There was no statistical difference between group B and group C. among the three groups, the incidence of hypocalcemia in group B was the highest, and the lowest in group A was 47.9. 31.2. 17.2 the incidence of hypocalcemia symptoms was 25.5in group B (P 0.05), which was higher than that in group C (P 0.05). There was no significant difference between group C and group C (4. 1). The serum calcium value of the symptom group was 95% CI. [Conclusion during the perioperative period of 1: 1, the level of PTH decreased first and then increased, and the lowest level appeared at 1-3 days after operation. However, it took more than 2 weeks to recover to the preoperative level. The basic level of PTH in women was higher than that in men (3. 3 vs ULI and UCND). TT and BCND are more likely to lead to lower PTH levels. 4TT is more likely to cause hypocalcemia. 52 autografts of parathyroid glands have no significant effect on blood PTH and serum calcium levels after DTC. 2 g for high risk patients with hypocalcemia. Bid intravenous infusion of calcium gluconate 10% was helpful to reduce the incidence of hypocalcemia. And maintain the appropriate level of blood calcium at 1.8 mmol / L of blood calcium should be highly alert to the occurrence of hypocalcemia symptoms.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R736.1

【相似文献】