甲状旁腺腺瘤大小与甲状旁腺功能及甲状腺功能的相关性研究

目的　分析甲状旁腺腺瘤（PTA）患者合并甲状腺疾病的情况，探讨PTA的大小与甲状旁腺功能及甲状腺功能的关系。方法　选取华北理工大学附属医院收治的100例PTA患者，依据是否合并甲状腺疾病将患者分为合并甲状腺疾病组（n=55）和非合并甲状腺疾病组（n=45）。收集患者临床资料，分析年龄、病程以及术前碱性磷酸酶（ALP）、校正血钙、血磷、肌酐、总三碘甲状腺原氨酸（TT3）、总甲状腺激素（TT4）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素（TSH）、甲状旁腺激素（PTH）水平与PTA大小的相关性。采用Logistic回归分析偏大腺瘤的危险因素，绘制受检者工作特征（ROC）曲线分析术前指标预测偏大腺瘤的临床价值。结果　合并甲状腺疾病组患者较非合并甲状腺疾病组患者腺瘤的病程短（P＜0.05）。PTA大小与校正血钙、PTH、血肌酐及病程呈正相关，与FT4呈负相关（P＜0.01）；术前PTH与校正血钙、ALP、肌酐水平及病程呈正相关，与血磷、TT4和FT4呈负相关（P＜0.01）；术前TT4水平与校正血钙、ALP、肌酐水平及病程呈负相关，与血磷、FT4水平呈正相关（P＜0.05）；术前FT4水平与校正血钙、FT3水平及病程呈负相关（P＜0.01）。Logistic回归分析显示术前PTH高及病程长为预测偏大腺瘤的危险因素。ROC曲线提示术前PTH及病程联合检测可进一步提高预测偏大腺瘤的敏感度。结论　PTA大小与术前PTH水平呈正相关性，术前PTH水平及病程的联合考虑可成为偏大PTA的预测因子，推测甲状旁腺功能亢进对甲状腺的功能起到抑制性的作用。

Study on the correlation between the size of parathyroid adenoma and the function of parathyroid and thyroid

Objective　To analyze the situation of parathyroid adenoma (PTA) with thyroid disease, and discuss the relationship between the size of PTA and the function of parathyroid and thyroid. Methods One hundred patients with PTA admitted to the Affiliated Hospital of North China University of Technology were selected in this study. Patients were divided into two groups according to whether they were combined with thyroid diseases， including patients with thyroid disease group (n=55) and those without thyroid disease group (n=45). The clinical data of the patients were collected, and the correlation between preoperative indexes: age, course of the disease, alkaline phosphatase (ALP), corrected serum calcium, phosphorus, creatinine, total triiodothyronine (TT3), total thyroxine (TT4), free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), parathyroid hormone (PTH) and the size of PTA were analyzed. Logistic regression was used to analyze the risk factors of large adenoma, and receiver operating characteristic (ROC) curve was drawn to analyze the clinical value of preoperative indicators in predicting the larger adenoma. Results　Compared with patients without thyroid disease, a shorter adenoma course was found in the patients with thyroid disease (P＜0.05). There were positive correlations between the size of PTA and corrected serum calcium, PTH, serum creatinine, and course of disease. There was a negative correlation between the size of PTA and FT4 (P＜0.01). Preoperative PTH was positively correlated with corrected blood calcium, ALP, creatinine levels and disease course, and negatively correlated with blood phosphorus, TT4 and FT4 (P＜0.01). Preoperative TT4 level was negatively correlated with corrected blood calcium, ALP, creatinine levels and disease course, and positively correlated with blood phosphorus and FT4 levels (P＜0.05). Preoperative FT4 level was negatively correlated with adjusted blood calcium, FT3 level and disease course (P＜0.01). Logistic regression analysis found that preoperative PTH and disease course were risk factors for predicting large adenomas. The ROC curve suggested that the combined detection of PTH and disease course before surgery can further improve the sensitivity of predicting large adenomas. Conclusion　The size of PTA is positively correlated with preoperative PTH level. The combined consideration of preoperative PTH and course of disease could be a predictor of larger PTA, suggesting that hyperparathyroidism may inhibit thyroid function.