原发性甲状旁腺机能亢进症误诊原因分析与定性诊断

An Analysis of Misdiagnostic Causes and Qualitative Diagnosis of Primary Hyperparathyroidism

为分析原发性甲状旁腺机能亢进症（原发性甲旁亢）误诊原因，总结本病定性诊断的体会，对１９８６～１９９７年收治的２２例原发性甲旁亢患者进行了回顾性分析。结果发现２２例均误诊，平均病程４．５±１．２年。原发性甲旁亢早期表现复杂多样且缺乏特异性；医生对本病缺乏认识和诊治经验；以及实验室诊断的局限性等是临床误诊的主要原因。结果提示：①提高对原发性甲旁亢的认识，重视其早期症状，是定性诊断的重要线索；②对可疑病例应反复多次测定血钙和血磷、２４小时尿钙和尿磷，以及血清碱性磷酸酶等，并结合临床及Ｘ线检查综合分析是定性诊断的主要根据；③普通Ｘ线检查对原发性甲旁亢的定性诊断有重要价值。

To analyse the misdiagnostic causes of primary hyperparathyroidism (PHT) and sum up the experience about the qualitative diagnosis of the desease; we studied 22 cases who were treated in our hospital from 1986～1997 retrospectively; All of the 22 cases were misdiagnosed. The average course of disease was 4.5±1.2 years. The important causes of misdiagnosis were as follows: a variety of nonspecific clinical manifestation at the early stage of the disease, poor understanding of the disease and lack of experience of diagnosis and treatment on the part of the doctors, and the limitation of laboratory data for the diagnosis. The results suggest that: ① understanding the clinical characteristic and paying attention to the early symptoms are the important clues of the correct diagnosis; ② combined analysis of the results of the level of calcium and phosphorus in serum and in 24 hour urine, and serum alkaline phosphalase, with clinical manifestation and X ray finding are the main ways of correct diagnosis; ③ X ray examination has a great value to the correct diagnosis of the disease.