原发性甲状旁腺功能亢进症51例临床分析

Clinical analysis for 51 cases of primary hyperparathyroidism

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5l例PHPT患者的临床资料，进行回颐性分析.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）、血甲状旁腺素令段（iPTH）、CT或者99mTc-氧基异丁基异腈双时相显像（99mTcMIBI）检查诊断。结果PH盯临床表现以骨型由专常弛，占51％（26／51）。病凶中腺瘤最多见，占72％（34／47）。原位病变以有下檄最常见，占41％（19／46），其次为左下微，占28％（13／46），异化病变占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±O．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99mTcMIBI的检出率分别为88％（35／40）、97％（30／3I）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、影像学等检佥有助于避免误诊；联合99mTc－MIBI和CT可提高术前定位的准确性。

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 iniferior 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, rbeulnatic 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） retool/L, （1455±1091） U/L and （1669±515） ng/L, respectively] and in patients with parathyroid carcinoma [ （ 3.46 ± 0.40 ） retool/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% （30/3l） 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 99mTcTeMIBI imaging can improve accuracy of preoperative localization diagnosis.