彩超在维持性血液透析患者继发性甲状旁腺功能亢进症诊断的价值

Application value of color Doppler ultrasonography for diagnosing secondary hyperparathyroidism in maintenance hemodialysis patients

目的 :评价彩色多普勒超声(colour Doppler flow image,CDFI)对维持性血液透析(maintenance hemodialysis,MHD)患者继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)时甲状旁腺增生的诊断价值。方法:MHD并伴有不同程度的血中全段甲状旁腺激素(intact parathyroid hormone,iPTH)水平增高的患者62例,比较分析其甲状旁腺CDFI检查与血清学iPTH、血钙(Ca)、血磷(P)、钙磷乘积、尿素氮(blood urea nitroge,BUN)及肌酐(serum creatinine,SCr)检查结果。结果:62例MHD中检出存在甲状旁腺增生4例,共检出增生的甲状旁腺178枚。增生的甲状旁腺边界清晰,形态多样,呈极低回声改变,内部回声均匀或欠均匀,可见不同程度的钙化,少数表现为结节状的偏高回声团。CDFI显示内部及周边有不同程度的血流分布。统计结果显示增生的甲状旁腺直径与血iPTH、血钙水平呈正相关,与P、BUN、SCr无明显相关性。结论:通过CDFI观察甲状旁腺的数目、大小、内部回声、血供情况可以在一定程度上反映了SHPT的严重程度,为SHPT治疗方案的选择及术前定位诊断提供参考依据。

Objective：To evaluate the value of color Doppler ultrasonography for diagnosing secondary hyperparathyroidism（SHPT） in maintenance hemodialysis（MHD）patients.Methods：Parathyroid glands was examined by Doppler echocardiography,and some biochemical parameters such as serum levels of intact parathyroid hormone（iPTH）,total calcium,phosphorus,calcium phosphorus product,blood urea nitrogen（BUN） and serum creatinine（Cr） were also detected in 62 patients with MHD complicated with different degrees of iPTH increase.The relationship among the laboratory data was explored.Results：Of 62 cases of MHD,4 cases were found parathyroid glands hyperplasia by ultrasonography and 178 hyperplastic parathyroids were detcted.The hyperplastic parathyroids showed clear borderline,various shapes,lowest hypoechoic signals,asymmetrical or uniform inner resonance and different degrees of calcification,but a few cases presented nodular hyperechogenic mass.The color Doppler flow imaging（CDFI） revealed varying degrees of blood distribution in internal and peripheral masses.The statistical results showed that the diameter of hyperplastic parathyroid was positively related to the serum level of calcium and iPTH,but not related to the serum level of phosphorus,BUN and Cr.Conclusion：Observing the amount,volume,inner resonance and blood supply of parathyroid glands by CDFI can reflect the severity of SHPT to a certain extent and provide the definite basis for selecting the treatment scheme and preoperative positioning diagnosis of SHPT.