中华全科医师杂志
中華全科醫師雜誌
중화전과의사잡지
CHINESE JOURNAL OF GENERAL PRACTITIONERS
2011年
12期
876-879
,共4页
李硕良%黄知敏%卫国红%肖海鹏%李延兵
李碩良%黃知敏%衛國紅%肖海鵬%李延兵
리석량%황지민%위국홍%초해붕%리연병
甲状旁腺功能亢进%原发性%诊断技术,内分泌%诊断,鉴别%治疗
甲狀徬腺功能亢進%原髮性%診斷技術,內分泌%診斷,鑒彆%治療
갑상방선공능항진%원발성%진단기술,내분비%진단,감별%치료
Hyperparathyroidism,primary ( PHPT )%Diagnostic technique%Endocrine disease%Diagnosis,differential%Treatment
目的 探讨原发性甲状旁腺功能亢进症(PHPT)的临床特点、误诊状况及诊疗措施.方法 对我院1997年6月至2010年11月收治的51例PHPT患者的临床资料,进行回顾性分析.47例术后病理检查确诊,4例未手术者综合血钙、血碱性磷酸酶(ALP)、血甲状旁腺素全段(iPTH)、CT或者99mTc-甲氧基异丁基异腈双时相显像(99mTcMIBI)检查诊断.结果 PHPT临床表现以骨型最常见,占51％ (26/51).病因中腺瘤最多见,占72％( 34/47).原位病变以右下极最常见,占41％( 19/46),其次为左下极,占28％ (13/46),异位病变占10％( 5/51).PHPT易误诊,误诊率92％(47/51),较多误诊为泌尿系结石、风湿性疾病、原发性骨质疏松症等.不同临床类型、病理分型患者术前血钙、ALP及iPTH水平存在差异,以肾骨型及甲状旁腺癌患者水平最高,分别为(3.22±0.35)mmoL/L、( 1455±1091) U/L、( 1669±515) ng/L及(3.46±0.40) mmol/L、(1410±426) U/L、(1861±768) ng/L.术前定位甲状旁腺彩色超声、CT及99m TcMIBI的检出率分别为88％ (35/40)、97％(30/31)和97％(31/32).结论 PHPT误诊率高,血钙应列为常规体检项目,辅以ALP、iPTH、影像学等检查有助于避免误诊;联合99mTc-MIBI和CT可提高术前定位的准确性.
目的 探討原髮性甲狀徬腺功能亢進癥(PHPT)的臨床特點、誤診狀況及診療措施.方法 對我院1997年6月至2010年11月收治的51例PHPT患者的臨床資料,進行迴顧性分析.47例術後病理檢查確診,4例未手術者綜閤血鈣、血堿性燐痠酶(ALP)、血甲狀徬腺素全段(iPTH)、CT或者99mTc-甲氧基異丁基異腈雙時相顯像(99mTcMIBI)檢查診斷.結果 PHPT臨床錶現以骨型最常見,佔51％ (26/51).病因中腺瘤最多見,佔72％( 34/47).原位病變以右下極最常見,佔41％( 19/46),其次為左下極,佔28％ (13/46),異位病變佔10％( 5/51).PHPT易誤診,誤診率92％(47/51),較多誤診為泌尿繫結石、風濕性疾病、原髮性骨質疏鬆癥等.不同臨床類型、病理分型患者術前血鈣、ALP及iPTH水平存在差異,以腎骨型及甲狀徬腺癌患者水平最高,分彆為(3.22±0.35)mmoL/L、( 1455±1091) U/L、( 1669±515) ng/L及(3.46±0.40) mmol/L、(1410±426) U/L、(1861±768) ng/L.術前定位甲狀徬腺綵色超聲、CT及99m TcMIBI的檢齣率分彆為88％ (35/40)、97％(30/31)和97％(31/32).結論 PHPT誤診率高,血鈣應列為常規體檢項目,輔以ALP、iPTH、影像學等檢查有助于避免誤診;聯閤99mTc-MIBI和CT可提高術前定位的準確性.
목적 탐토원발성갑상방선공능항진증(PHPT)적림상특점、오진상황급진료조시.방법 대아원1997년6월지2010년11월수치적51례PHPT환자적림상자료,진행회고성분석.47례술후병리검사학진,4례미수술자종합혈개、혈감성린산매(ALP)、혈갑상방선소전단(iPTH)、CT혹자99mTc-갑양기이정기이정쌍시상현상(99mTcMIBI)검사진단.결과 PHPT림상표현이골형최상견,점51％ (26/51).병인중선류최다견,점72％( 34/47).원위병변이우하겁최상견,점41％( 19/46),기차위좌하겁,점28％ (13/46),이위병변점10％( 5/51).PHPT역오진,오진솔92％(47/51),교다오진위비뇨계결석、풍습성질병、원발성골질소송증등.불동림상류형、병리분형환자술전혈개、ALP급iPTH수평존재차이,이신골형급갑상방선암환자수평최고,분별위(3.22±0.35)mmoL/L、( 1455±1091) U/L、( 1669±515) ng/L급(3.46±0.40) mmol/L、(1410±426) U/L、(1861±768) ng/L.술전정위갑상방선채색초성、CT급99m TcMIBI적검출솔분별위88％ (35/40)、97％(30/31)화97％(31/32).결론 PHPT오진솔고,혈개응렬위상규체검항목,보이ALP、iPTH、영상학등검사유조우피면오진;연합99mTc-MIBI화CT가제고술전정위적준학성.
Objective To study clinical characteristics,causes of misdignosis and diagnostic and therapeutic methods for primary hyperparathyroidism (PHPT).Methods Retrospective analysis was done for 51 patients of PHPT,47 confirmed by biopsy after surgical operation and 4 without operation diagnosed based on their serum levels of calcium,alkaline phosphatase ( ALP),intact parathyroid hormone ( iPTH ),and computed tomography (CT) or 99mtechnetium sestamibi (99mTcMIB1) imaging at the First Affiliated Hospital of Sun Yat-sen University,Guangzhou during June 1997 to November 2010.Results Bone-related complications were the most common clinical manifestation,accounting for 51％ (26/51 ) of the cases,and adenoma,a benign,enlarged and hyperactive parathyroid gland,in 34 of 47 cases ( 72％ ).In orthotopic lesions,the right inferior was affected in 19 of 46 cases (41％),followed by the left inferior in 13 cases (28％),while 5 of 51 cases (10％) with ectopic parathyroid gland.PHPT was easily misdiagnosed as urolithiasis,rheumatic disease,primary osteoporosis,etc,accounting for 92％ of the cases in our study.Preoperative serum levels of calcium,ALP and iPTH in the patients varied with their clinical type and pathological classification,the highest in patients with urolithiasis-bone-related complications [ (3.22 ±0.35) mmol/L,(1455 ± 1091 ) U/L and (1669 ± 515 ) ng/L,respectively ] and in patients with parathyroid carcinoma [ (3.46 ± 0.40) mmol/L,( 1410 ± 426) U/L and ( 1861 ± 768) ng/L,respectively ].Sensibility of preoperative localization diagnosis using ultrasonography,CT and 99mTcMIBI was 88％ (35/40),97％ (30/31) and 97％ (31/32),respectively.Conclusions PHPT is frequently misdiagnosed as other diseases.Measurement of serum calcium should be included in routine physical examinations,supplemented with measurement of serum ALP and iPTH,as well as medical imaging,which can help avoid misdiagnosis.CT combined with 99mTcMIBI imaging can improve accuracy of preoperative localization diagnosis.
