难治性继发性甲状旁腺功能亢进症患者病理结果临床分析

目的分析外科手术切除的甲状旁腺标本病理结果,探讨其对难治性继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)患者的临床意义。方法回顾性分析82例难治性继发性甲状旁腺功能亢进症患者资料,增生甲状旁腺全切患者67例。53例手术前行99mTc-MIBI双时相平面显像和彩色多普勒超声2项检查定位,另外14例手术前仅行彩色多普勒超声检查定位,比较2种影像学检查方法的准确率,并分析术前最后1次血清全段甲状旁腺激素(intact parathyroid hormone,iPTH)与切除的不同病理类型甲状旁腺体积之和的关系。结果手术切除的甲状旁腺标本病理结果为单纯性增生的腺体体积之和与患者术前血清iPTH呈显著正相关(r=0.365,P=0.006),增生伴钙化的甲状旁腺腺体体积之和与术前最后1次血清iPTH无明显相关性(r=-0.308,P=0.356)。99mTc-MIBI平面显像、彩色多普勒超声及两种方法联合检查对增生甲状旁腺定位诊断准确率依次为128/212(60.38%),203/259(78.38%),172/212(81.19%),高频超声相对于99mTc-MIBI平面显像对SHPT的增生腺体准确率比较高(χ2=18.080,P=0.000),有统计学意义。2种检查联合应用的准确率优于多普勒超声(χ2=0.545,P=0.460),无统计学意义,而2种检查联合应用的准确率优于99mTc-MIBI核医学检查(χ2=22.066,P=0.000),有统计学意义。结论术前iPTH值不能完全反应难治性SHPT患者的严重程度,彩色多普勒超声对难治性SHPT增生腺体的筛查是一项简单有效的方法,可作为难治性SHPT外科手术前的首选辅助检查。

Clinical value of pathological examination of uremic patients with refractory secondary hyperparathyroidism

Objective To analyze the pathology results of excised hyperplastic parathyroid glands for detecting uremic patients with refractory secondary hyperparathyroidism （SHPT）.Methods Eighty-two uremic patients were analyzed retrospectively.The diagnosis of hyperparathyroidism was confirmed by surgery and pathological examination.Total parathyroidectomy was performed in 67 patients,in whom 53 patients accepted parathyroid imaging of color Doppler ultrasonography and ^99mTc-MIBI biphasic scintigraphy,and 14 patients were examined only by color Doppler ultrasonography before surgery.The diagnostic sensitivity of the two parathyroid imaging methods were compared base on the pathology of excised parathyroid samples.The correlation between serum intact parathyroid hormone （iPTH） just before the surgery and the volume and calcification of excised hyperplastic parathyroid was evaluated.Results Pathologically,hyperplasia or hyperplasia with calcification was found in all excised parathyroid samples.Serum iPTH level was positively correlated with the size of hyperplastic parathyroid （r=0.365,P=0.006）,but not with the size of the hyperplastic parathyroid with calcification （r=-0.308,P=0.356）.The sensitivity for the localization of hyperplastic parathyroid was 60.38% （128/212 samples）,78.37% （203/259 samples）,and 81.19% （172/212 samples） by color Doppler ultrasonography,^99mTc-MIBI biphasic scintigraphy,and combination of the two methods,respectively.The sensitivity by color Doppler ultrasonography was higher than that by ^99mTc-MIBI biphasic scintigraphy （Х^2=18.084,P=0.000）.The sensitivity by combination of the two methods was higher than that by ^99mTc-MIBI biphasic scintigraphy （Х^2=22.066,P=0.000）,but was statistical indifferent from that by color Doppler ultrasonography （Х^2=0.545,P=0.460）.Conclusions Serum iPTH level was absolutely unrelated to the illness degree of uremic patients.While ^99mTc-MIBI biphasic scintigraphy is an effective method for the localization of refractory SHP