CAJ | 학술논문

目的：探讨甲状旁腺腺瘤并原发性甲状旁腺功能亢进症（ primary hyperparathyroidism, PHPT)的临床表现、诊断方法及早期监测措施,分析误诊原因及防范措施。方法回顾性分析北京大学人民医院2006年1月—2013年12月收治的28例经手术及病理检查证实为甲状旁腺腺瘤并 PHPT 的临床资料。结果28例血钙（3．02±0．40)mmol/L,血全段甲状旁腺激素（parathyroid hormone, PTH)（468．0±425．0)pg/ml。24例行甲状旁腺超声检查,诊断敏感性为75．0%。17例行颈部CT检查,诊断敏感性为76．5%。21例行锝99-甲氧基异丁基异腈（99mTc-MIBI)核素显像检查,诊断敏感性为100%。血钙检测结合甲状腺超声检查诊断敏感性95．8%。将28例按照靶器官主要受损情况分为单纯高钙组、骨病变组、泌尿系结石组及骨病变加泌尿系结石组4组。4组性别、年龄、病程、血钙、血磷、24 h尿钙、24 h尿磷、血全段PTH、血碱性磷酸酶比较差异均无统计学意义（ P>0．05)。线性回归分析显示血钙及血全段PTH与靶器官主要受损各组、年龄、性别、病程、血磷、24 h尿钙、24 h尿磷、血碱性磷酸酶水平无独立相关性,且血钙与血全段PTH之间亦无相关性。本组20例曾误诊,误诊率71．4%,其中8例误诊为单纯泌尿系结石,4例误诊为骨关节炎,3例误诊为糖尿病,2例误诊为骨肿瘤,2例误诊为原发性骨质疏松,1例误诊为腰椎间盘突出。结论血钙和血全段PTH均无法预测PHPT靶器官选择性和靶器官损害程度。血钙检测结合甲状旁腺超声检查简便、易操作,对于早期筛查PHPT,减少严重骨病变及肾脏结构、功能改变具有重要意义。
목적：탐토갑상방선선류병원발성갑상방선공능항진증（ primary hyperparathyroidism, PHPT)적림상표현、진단방법급조기감측조시,분석오진원인급방범조시。방법회고성분석북경대학인민의원2006년1월—2013년12월수치적28례경수술급병리검사증실위갑상방선선류병 PHPT 적림상자료。결과28례혈개（3．02±0．40)mmol/L,혈전단갑상방선격소（parathyroid hormone, PTH)（468．0±425．0)pg/ml。24례행갑상방선초성검사,진단민감성위75．0%。17례행경부CT검사,진단민감성위76．5%。21례행득99-갑양기이정기이정（99mTc-MIBI)핵소현상검사,진단민감성위100%。혈개검측결합갑상선초성검사진단민감성95．8%。장28례안조파기관주요수손정황분위단순고개조、골병변조、비뇨계결석조급골병변가비뇨계결석조4조。4조성별、년령、병정、혈개、혈린、24 h뇨개、24 h뇨린、혈전단PTH、혈감성린산매비교차이균무통계학의의（ P>0．05)。선성회귀분석현시혈개급혈전단PTH여파기관주요수손각조、년령、성별、병정、혈린、24 h뇨개、24 h뇨린、혈감성린산매수평무독립상관성,차혈개여혈전단PTH지간역무상관성。본조20례증오진,오진솔71．4%,기중8례오진위단순비뇨계결석,4례오진위골관절염,3례오진위당뇨병,2례오진위골종류,2례오진위원발성골질소송,1례오진위요추간반돌출。결론혈개화혈전단PTH균무법예측PHPT파기관선택성화파기관손해정도。혈개검측결합갑상방선초성검사간편、역조작,대우조기사사PHPT,감소엄중골병변급신장결구、공능개변구유중요의의。
Objective We summarized the clinical manifestation, diagnostic method and early monitoring measures of parathyroid adenoma with primary hyperparathyroidism (PHPT), which was beneficial to analyze the cause of misdiagnosis and develop preventive measures. Methods A retrospective study of patients diagnosed with of parathyroid adenoma with PHPT confirmed by surgical excision and biopsy in the People's Hospital of Beijing University during January 2006 and Decem-ber 2013 was undertaken. Clinical presentation, medical history, biochemistry, radiology, biopsy and surgical notes were re-corded. Results A total of 28 cases of PHPT were reviewed. Mean serum calcium concentration was (3.03 ±0.40)mmol/L, while mean serum intact PTH concentration was (468.0 ±425.0)pg/ml. Ultrasonography was per-formed on 24 patients and the diagnostic sensitivity was 75. 0%. Neck CT scanning was carried out in 17 cases and the diag-nostic positive rate was 76. 4%. 99m Tc-MIBI was performed on 21 patients and diagnostic positive rate was 100%. Blood calci-um monitoring combined with ultrasonography diagnostic positive rate was 95. 8%. All the patients were divided into 4 groups according to the target organs affected:blood calcium heightening group, bone injury group, urethral calculi group, bone inju-ry and urethral calculi group. No significant differences were detected among groups about age, gender, course of disease, blood calcium, blood phosphorus, 24 h urine calcium, 24 h urine phosphorus and ALP levels (P>0. 05). Linear regression analysis showed that blood calcium and parathyroid hormone did not have significant correlation with groups, age, gender, blood phosphorus, 24 h urine calcium, 24 h urine phosphorus, and ALP levels. There was no significant correlation between blood calcium levels and intact PTH. Misdiagnosis rate of this group was 71. 4% (20 cases). Among them, 8 patients were misdiagnosed as having pure urinary calculi, 4 patients were misdiagnosed as having osteoarthritis, 3 patients were misdiag-nosed as having diabetes mellitus, 2 patients were misdiagnosed as having bone tumors, 2 patients were misdiagnosed as hav-ing primary osteoporosis patients, and 1 patient was misdiagnosed as having lumbar disc. Conclusion Blood calcium and in-tact PTH do not predict the selectivity and degree of damage of target organs of PHPT. Blood calcium monitoring combined with parathyroid Ultrasound is simple and easy to operate. Early screening of parathyroid beat is beneficial in reducing severe bone lesions, kidney structure and functional changes.