中华内分泌代谢杂志
中華內分泌代謝雜誌
중화내분비대사잡지
CHINESE JOURNAL OF ENDOCRINOLOGY AND METABOLISM
2015年
4期
300-305
,共6页
原发性甲状旁腺功能亢进症%诊断%治疗
原髮性甲狀徬腺功能亢進癥%診斷%治療
원발성갑상방선공능항진증%진단%치료
Primary hyperparathyroidism%Diagnosis%Treatment
目的 探讨原发性甲状旁腺功能亢进症(PHPT)患者的临床特点、诊断及治疗.方法 回顾性分析1991年至2013年间武汉同济医院收治的89例PHPT患者的临床资料.结果 男女比例约1∶2.1,平均年龄(44.7±15.8)岁.70例(79％)患者属于症状型.总体误诊率为62％.误诊患者中,52％的患者被误诊为肾结石和骨病(包括骨折、代谢性骨病、骨肿瘤),其余被误诊为消化性溃疡、类风湿性关节炎或胰腺炎.甲状旁腺激素(PTH)697.3 pg/ml(26.4 ～5 000.0 pg/ml,n=88),血钙(3.03±0.56) mmol/L(n=88),24 h尿钙(10.02±4.73) mmol/24 h(n=36).术前影像学检查,99m锝-甲氧基异丁基异腈(99mTc-MIBI)的敏感性(96％)大于超声(71％)、电子计算机断层扫描(CT)(71％)和磁共振成像(MRI)(72％)的敏感性(P＜0.05),后三者间差异无统计学意义(P＞0.05).共79例患者行手术治疗,手术成功率99％,病理证实有67例(85％)腺瘤[其中62例单一腺瘤、1例多发腺瘤、4例异位腺瘤(分别异位于甲状腺下方、胸廓、左纵膈、胸骨上方)]、7例(9％)增生、3例(4％)囊肿、2例(3％)腺癌.79例手术患者的术前PTH748.2 pg/ml(46.1～5000.0 pg/ml),病灶切除15 min后PTH 79.9 pg/ml(11.35 ～ 838.0 pg/ml),术后1dPTH22.9 pg/ml(2.3 ～1 203.0 pg/ml)(三个时间点两两比较,P＜0.05).术前血钙(3.03±0.56) mmol/L,术后1d血钙(2.25±0.37)mmol/L(与术前比较P＜0.05),术后2d血钙浓度(2.08±0.36) mmol/L(与术前比较P＜0.05,与术后1d比较P＞0.05).术后有42例(53％)患者诉口周及四肢麻木,2例(3％)出现声嘶和饮水呛咳,1例(1％)出现手足搐搦,经补钙及对症支持治疗后均好转.结论 国内PHPT以症状型患者为主,误诊率仍很高,首诊医师应加深对该疾病发病机制及多样化临床表现的认识.血钙和PTH的联合测定是诊断的主要依据.术前影像学检查首选99mTc-MIBI,其次是超声、CT和MRI.手术是安全有效的治疗手段.
目的 探討原髮性甲狀徬腺功能亢進癥(PHPT)患者的臨床特點、診斷及治療.方法 迴顧性分析1991年至2013年間武漢同濟醫院收治的89例PHPT患者的臨床資料.結果 男女比例約1∶2.1,平均年齡(44.7±15.8)歲.70例(79％)患者屬于癥狀型.總體誤診率為62％.誤診患者中,52％的患者被誤診為腎結石和骨病(包括骨摺、代謝性骨病、骨腫瘤),其餘被誤診為消化性潰瘍、類風濕性關節炎或胰腺炎.甲狀徬腺激素(PTH)697.3 pg/ml(26.4 ～5 000.0 pg/ml,n=88),血鈣(3.03±0.56) mmol/L(n=88),24 h尿鈣(10.02±4.73) mmol/24 h(n=36).術前影像學檢查,99m锝-甲氧基異丁基異腈(99mTc-MIBI)的敏感性(96％)大于超聲(71％)、電子計算機斷層掃描(CT)(71％)和磁共振成像(MRI)(72％)的敏感性(P＜0.05),後三者間差異無統計學意義(P＞0.05).共79例患者行手術治療,手術成功率99％,病理證實有67例(85％)腺瘤[其中62例單一腺瘤、1例多髮腺瘤、4例異位腺瘤(分彆異位于甲狀腺下方、胸廓、左縱膈、胸骨上方)]、7例(9％)增生、3例(4％)囊腫、2例(3％)腺癌.79例手術患者的術前PTH748.2 pg/ml(46.1～5000.0 pg/ml),病竈切除15 min後PTH 79.9 pg/ml(11.35 ～ 838.0 pg/ml),術後1dPTH22.9 pg/ml(2.3 ～1 203.0 pg/ml)(三箇時間點兩兩比較,P＜0.05).術前血鈣(3.03±0.56) mmol/L,術後1d血鈣(2.25±0.37)mmol/L(與術前比較P＜0.05),術後2d血鈣濃度(2.08±0.36) mmol/L(與術前比較P＜0.05,與術後1d比較P＞0.05).術後有42例(53％)患者訴口週及四肢痳木,2例(3％)齣現聲嘶和飲水嗆咳,1例(1％)齣現手足搐搦,經補鈣及對癥支持治療後均好轉.結論 國內PHPT以癥狀型患者為主,誤診率仍很高,首診醫師應加深對該疾病髮病機製及多樣化臨床錶現的認識.血鈣和PTH的聯閤測定是診斷的主要依據.術前影像學檢查首選99mTc-MIBI,其次是超聲、CT和MRI.手術是安全有效的治療手段.
목적 탐토원발성갑상방선공능항진증(PHPT)환자적림상특점、진단급치료.방법 회고성분석1991년지2013년간무한동제의원수치적89례PHPT환자적림상자료.결과 남녀비례약1∶2.1,평균년령(44.7±15.8)세.70례(79％)환자속우증상형.총체오진솔위62％.오진환자중,52％적환자피오진위신결석화골병(포괄골절、대사성골병、골종류),기여피오진위소화성궤양、류풍습성관절염혹이선염.갑상방선격소(PTH)697.3 pg/ml(26.4 ～5 000.0 pg/ml,n=88),혈개(3.03±0.56) mmol/L(n=88),24 h뇨개(10.02±4.73) mmol/24 h(n=36).술전영상학검사,99m득-갑양기이정기이정(99mTc-MIBI)적민감성(96％)대우초성(71％)、전자계산궤단층소묘(CT)(71％)화자공진성상(MRI)(72％)적민감성(P＜0.05),후삼자간차이무통계학의의(P＞0.05).공79례환자행수술치료,수술성공솔99％,병리증실유67례(85％)선류[기중62례단일선류、1례다발선류、4례이위선류(분별이위우갑상선하방、흉곽、좌종격、흉골상방)]、7례(9％)증생、3례(4％)낭종、2례(3％)선암.79례수술환자적술전PTH748.2 pg/ml(46.1～5000.0 pg/ml),병조절제15 min후PTH 79.9 pg/ml(11.35 ～ 838.0 pg/ml),술후1dPTH22.9 pg/ml(2.3 ～1 203.0 pg/ml)(삼개시간점량량비교,P＜0.05).술전혈개(3.03±0.56) mmol/L,술후1d혈개(2.25±0.37)mmol/L(여술전비교P＜0.05),술후2d혈개농도(2.08±0.36) mmol/L(여술전비교P＜0.05,여술후1d비교P＞0.05).술후유42례(53％)환자소구주급사지마목,2례(3％)출현성시화음수창해,1례(1％)출현수족휵닉,경보개급대증지지치료후균호전.결론 국내PHPT이증상형환자위주,오진솔잉흔고,수진의사응가심대해질병발병궤제급다양화림상표현적인식.혈개화PTH적연합측정시진단적주요의거.술전영상학검사수선99mTc-MIBI,기차시초성、CT화MRI.수술시안전유효적치료수단.
Objective To summarize the clinical manifestations,diagnosis and treatment of the primary hyperparathyroidism (PHPT).Methods The clinical data of 89 patients with PHPT admitted during 1991 to 2013 were retrospectively analyzed.Results The mean age of the 89 patients was (44.7 ± 15.8) years (13-86 years),male to female ratio was 1 ∶ 2.1.79％ of the 89 patients were symptomatic.62％ of the 89 patients had been misdiagnosed.52％ had been misdiagnosed as kidney stones or bone diseases (fracture,tumor,and metabolic bone disease).The remaining subjects had been misdiagnosed as peptic ulcer,rheumatoid arthritis or pancreatitis.The median serum parathyroid hormone (PTH) level in 88 patients was 697.3 pg/ml (26.4-5 000.0 pg/ml,n =88),the mean serum calcium level was (3.03 ± 0.56) mmol/L (n =88).The 24 h urine calcium was (10.02 ± 4.73)mmol/24 h (n =36).The sensitivity of localization of the parathyroid lesions with technetium-99m methoxy-isobutylisonitrile (99mTc-MIBI) was 96％,being higher than ultrasound (71％),CT (71％),and MRI (72％) (P＜0.05,respectively).79 cases had been treated surgically.The median serum PTH level was 748.2 pg/ml (46.1-5 000.0 pg/ml) before surgery,79.9 pg/ml (11.35-838.0 pg/ml) 15 minutes after surgical removal of the lesions (P＜0.05 vs preoperative) and 22.9 pg/ml (2.3-1 203.0 pg/ml) on the first postoperative day (P＜0.05 vs preoperative).Serum calcium was (3.03 ± 0.56) mmol/L before surgery,(2.25 ± 0.37) mmol/L on the first postoperative day (P＜0.05 vs preoperative) and (2.08 ± 0.36) mmol/L on the second postoperative day (P＜ 0.05 vs preoperative).After the operation,42 cases(53％) had perioral and limb numbness,2 cases (3％) had hoarseness of voice and bucking while drinking,1 case(1％) had tetany.All these symptoms were improved after calcium supplementation.67 patients (85％) had been diagnosed as parathyroid adenoma pathologically,7 patients (9％) as hyperplasia,3 patients (4％)as cysts,and 2 patients (3％) as carcinoma.Among 67 cases of adenomas,62 cases had a single parathyroid adenoma,1 case with multiple parathyroid adenomas,and 4 cases with ectopic parathyroid adenomas.The ectopic lesions were located below the thyroid,in the rib cage,left mediastinum,and above the sternum.Conclusions The majority of domestic PHPT was symptomatic.Delayed diagnosis of PHPT is still very frequent.The clinical presentations of PHPT are variable,determination of serum calcium and PTH level simultaneously is the keypoint for early identification and diagnosis of PHPT.The clinician should be familiar with the various clinical manifestations of PHPT and thus enhance understanding of pathogenesis of the disease.99mTc-MIBI scintigraphy remained the first choice of preoperative imaging localization of the parathyroid lesions,followed by ultrasound,CT,and MRI.Surgical removal of the lesions is effective and safe.
