高频超声筛查甲状旁腺探讨反复发作泌尿系结石与原发性甲状旁腺功能亢进的关系

Discussion of relationship between primary hyperparathyroidism and recurrent urinary calculi with high frequency ultrasound parathyroid scaning

目的应用高频超声筛查甲状旁腺探讨泌尿系结石与原发性甲状旁腺功能亢进(PHPT)的关系。方法对200例泌尿系结石患者(结石组)及200例健康体检者(对照组)行甲状旁腺超声扫查,观察甲状旁腺显示情况及病变;并对超声发现异常者行血清甲状旁腺激素(PTH)、血钙、血磷检查。结果结石组中,高频超声显示甲状旁腺136例(136/200,68.00%),发现甲状旁腺肿块28例(28/200,14.00%),肿块体积(588.93±15.25)mm3。对照组中,高频超声显示甲状旁腺90例(90/200,45.00%),发现甲状旁腺肿块4例(4/200,2.00%),肿块体积(84.74±12.51)mm3。两组间高频超声甲状旁腺显示率、甲状旁腺肿块显示率及肿块体积差异均有统计学意义(P均<0.05)。结石组12例甲状旁腺肿块患者为PHPT,另16例及对照组4例甲状旁腺肿块患者血清PTH、血钙、血磷均正常。两组间PHPT发生率差异有统计学意义(P<0.05)。结石组泌尿系结石发作≥3次者PHPT发生率(7/53,13.21%)高于结石发作<3次者(5/147,3.40%;P<0.05)。超声显示12例PHPT均为单发肿块;7例接受甲状旁腺切除术,术后病理均为腺瘤;5例接受内科药物治疗。结论 PHPT是反复发作泌尿系结石的一个重要且易被忽略的原因,高频超声可作为反复发作泌尿系结石患者甲状旁腺的常规筛查手段。

Objective To explore the relationship between primary hyperparathyroidism （PHPT） and recurrent urinary calculi with high frequency ultrasound parathyroid scaning. Methods High frequency ultrasound parathyroid scaning was performed on 200 patients with urinary calculi （calculus group） and 200 physical examinees （control group） to observe the display rate and lesions. Those who with abnormal ultrasound features underwent the examines of serum parathyroid hor- mone （PTH）, calcium and phosphorus. Results In calculus group, parathyroid glands displayed in 136 cases （136/200, 68.00%） by high frequency ultrasound. Parathyroid tumor was found in 28 cases （28/200, 14.00%） and the volume of tumor was （588.93± 15.25）mm3. In control group, parathyroid glands displayed in 90 cases （90/200, 45.00 %） by high frequency ultrasound. Parathyroid tumor was found in 4 cases （4/200, 2.00%） and the volume of tumor was （84.74± 12.51）mm3. The differences of display rate and the size of tumor were statistically significant between the two groups （both P〈0.05）. A total of 12 cases in calculus group were PHPT, while the serum PTH, calcium and phosphorus of an- other 16 cases in calculus group and 4 cases in control group were normal. There was statistical difference of PHPT inci- dence rate between the two groups （P〈0.05）. In calculus group, the PHPT incidence rate of urinary calculus occurred≥3 times cases （7/53, 13.21%） was higher than that of urinary calculus occurred 〈3 times cases （5/147, 3, 40%; P〈 0.05）. Only single tumor was found by ultrasound in all of 12 PHPT cases. Among them, 7 cases underwent parathyroid resection with the pathology result as adenoma, 5 cases received medicine treatment. Conclusion PHPT is an important and easily overlooked cause of recurrent urinary calculus, and high frequency ultrasound can be used as a routine method to screen parathyroid for recurrent urinary calculus patients.