저칼슘혈증 예측지표로서 부갑상선 호르몬 검사반응시간에 따른 유용성

The Usefulness According to the Incubation Time of PTH as Prediction Index of Hypocalcemia

PTH 측정은 체내 칼슘 및 이온화 칼슘의 수치와 함께 갑상선 절제술 후 저칼슘혈증을 예측하는 유용한 지표로서 임상에서는 신속한 결과 보고를 요구하고 있으나 검사반응시간이 길어 이에 상응하지 못하고 있다. 따라서 본 연구는 PTH 검사반응시간에 변화를 주어 신속한 결과 보고를 함으로서, 저칼슘혈증 예측 지표의 유용성을 평가하고자 한다. 2009년 7~8월까지 PTH를 검사한 환자들(n=131)을 대상으로 하였으며, 검사방법은 면역방사계수법으로 반응시간은 18${\pm}$2시간(Overnight), 0.5, 3, 6시간으로 구분하여 상관관계, 정밀도(10회 반복), 회수율을 측정하였다. 또한 조기 저칼슘 혈증 예측지표의 유용성을 평가하기 위해 민감도, 특이도, 양성예측도, 정확도를 비교 분석 하였다. 상관관계에서는 overnight을 기준으로 0.5시간은 $R^2$=0.987, 3시간은 $R^2$=0.993, 6시간은 $R^2$=0.996로 나타났다. 정밀도(%CV${\pm}$SD)에서 0.5시간은 $15.92{\pm}15.54$, 3시간은 $6.91{\pm}7.38$, 6시간은 $4.30{\pm}4.69$, Overnight은 $4.59{\pm}2.59$로 측정되었다. 회수율(%Mean${\pm}$SD)에서 0.5시간은 $96.8{\pm}5.44$, 3시간은 $102.6{\pm}4.35$, 6시간은 $100.7{\pm}2.56$, Overnight은 $102.2{\pm}5.98$로 측정되었다. 양성 예측치(cut-off point=15 pg/mL)를 기준으로 저칼슘혈증을 예측할 때, 0.5시간일 때 민감도 97.5% 특이도 96.0% 양성예측도 86.6% 정확도 84.7%였고, 3시간일 때 민감도 97.5% 특이도 100% 양성예측도 100% 정확도 97.5%였고, 6시간일때 민감도 97.5% 특이도 92.3% 양성예측도 92.8% 정확도 90.6%였다. Overnight법과 비교할 때 검사반응시간 3시간에서 98.3%로 가장 높은 일치율을 보였고, Kappa와 상관관계 또한 우수하였다. 이에 검사반응시간을 3시간으로 단축시켜 신속한 결과를 보고함으로써 환자의 저칼슘혈증을 조기에 예측하여 칼슘제 투여 등 적절한 조치를 취하여 환자의 증상발현을 막을 수 있는 유용한 지표로 활용될 것이다.

Purpose: PTH (parathyroid hormone) level is a useful index for prediction of hypocalcemia after thyroidectomy. The fast results are required for an early diagnosis of hypocalcemia. In this study, we evaluated the PTH change according to incubation time, and investigated the usefulness of hypocalcemia diagnosis of PTH results in early incubation time. Materials and Methods: The subjects were 131 patients who had taken the PTH test from July to August in 2009. All experiments were used IRMA method. PTH value were evaluated with the correlation between precision (10 times repeat) and recovery rate and at 0.5, 3, 6 and $18{\pm}2$ (below overnight) hours following incubation time. Data analysis was investigated with relationship of the sensitivity, specificity, PPV (positive predictive value) and accuracy. Results: The correlation was time-dependent with levels reaching $R^2$=0.987 at 0.5 hours, $R^2$=0.993 at 3 hours and $R^2$=0.996 at 6 hours compare to overnight levels. The precision (%CV${\pm}$SD) were $15.92{\pm}15.54$ at 0.5 hours, $6.91{\pm}7.38$ at 3 hours, $4.30{\pm}4.69$ at 6 hours and $4.59{\pm}2.59$ at overnight. The recovery rate (%Mean${\pm}$SD) were $96.8{\pm}5.44$ at 0.5 hours, $102.6{\pm}4.35$ at 3 hours, $100.7{\pm}2.56$ at 6 hours and $102.2{\pm}5.98$ at overnight. When 15 pg/ml of overnight density was set up as criteria, we measured the sensitivity, specificity and PPV, accuracy at 0.5, 3, 6 hours. The sensitivity was shown to 97.5% at all times. The specificity was 96.0% at 0.5 hours, 100% at 3 hours and 92.3% at 6 hours for control, respectively. The PPV was 86.6% at 0.5 hours, 100% at 3 hours and 92.8% at 6 hours. The accuracy was shown to 84.7% at 0.5 hours, 97.5% at 3 hours and 90.6% at 6 hours. These data were accompanied by a corresponding PTH value of overnight incubation time, which significantly correlated with early time results. Conclusion: The values of PTH at 3 hours has favorable the rate of concordance of 94.1% and may be useful for prediction of hypocalcemia, and it responses to overnight incubation PTH values. Therefore, This method may be an attractive alternative to proper treatment to stop symptom revelation by giving a calcium agent to the patient.