原发性甲状旁腺功能亢进症37例诊治分析

目的探讨原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)的临床特点,减少误漏诊。方法回顾性分析我院2000年1月—2012年12月收治的37例PHPT的临床资料。结果本组女性多于男性,年龄19~77(56.19±11.40)岁,病程0.25~11.00(4.13±2.31)年。分别以骨骼病变、泌尿系病变、消化系统病变、非特异性精神症状为主要表现就诊。19例误诊,误诊率51.35%;误诊时间0.75~4.00(2.64±1.37)年;误诊为骨质疏松7例(18.92%),泌尿系结石4例(10.81%),骨折、胃溃疡各2例(5.41%),尿路感染、慢性浅表性胃炎、急性胰腺炎、自主神经功能紊乱各1例(2.70%)。37例均经B超、99Tcm-MIBI及CT检查得以确诊,确诊后行手术治疗,术后均有程度不同的低钙血症,经补钙和对症治疗后症状缓解。结论临床医师应加强对PHPT的认识,对疑诊患者及时行甲状旁腺激素、血钙、血清碱性磷酸酶检测以及甲状旁腺B超、CT、放射性核素扫描检查,以提高首诊正确率。

Diagnosis and Treatment of 37 Patients with Primary Hyperparathyroidism

Objective To investigate clinical characteristics of primary hyperparathyroidism （PHPT） in order to avoid misdiagnosis or missed diagnosis. Methods Clinical data of 37 patients with PHPT during January 2000 and December of 2012 was retrospectively analyzed. Results The patients were predominantly females, the average age was 19 -77 （56.19 ± 11. 40） years, and the average course of disease was 0.25 - 11.00 （4.13 ± 2.31 ） years. The main clinical man- ifestations were bone lesions, lesions of the urinary system, lesions of the digestive system and non-specific psychiatric symp- toms. Nineteen patients were misdiagnosed, and the misdiagnosis rate was 51.35% ; the misdiagnosis time was 0.75 -4.00 （2.64±1.37 ） years; 7 patients were misdiagnosed as having osteoporosis （ 18.92% ）, 4 as having lithanginria （ 10.81% ）, 2 as having fracture （5.41%） , 2 as having gastrohelcosis （5.41%） , and urinary tract infection, chronic superficial gastri- tis, acute pancreatitis, vegetative nerve functional disturbance was misdiagnosed in 1 patient （2.70%） respectively. All the 37 patients were confirmed after examinations of B ultrasound, 99Tcm-MIBI and CT scanning, and underwent surgeries after confirmation. All the patients had postoperative hypocalcemia in different degrees, and the symptoms were relieved after calci- um supplement and symptomatic treatment. Conclusion Clinicians should raise the awareness of PHPT, and the levels of se- rum parathyroid hormone and blood calcium, serum alkaline phosphatase detection,and examinations of B ultrasound for para- thyroid glands, CT and radionuclide scanning should be carried out as soon as possible so as to improve the accuracy of the first diagnosis.