声触诊组织定量技术联合常规超声对慢性肾功能不全继发甲状旁腺功能亢进患者的诊断价值

Preliminary study of virtual touch tissue quantification in the diagnosis of chronic renal failure with secondary hyperparathyroidism

目的研究声触诊组织定量技术(VTQ)在慢性肾功能不全致继发性甲状旁腺功能亢进症(SHPT)中甲状旁腺检查及切除术(PTX)指征的应用价值。方法研究2013年10月至2014年6月在首都医科大学附属北京朝阳医院进行维持性血液透析的肾功能不全患者95例,以单个腺体任意一径≥5 mm为增生腺体,二维及彩色多普勒超声检查增生腺体数目、超声表现,计算腺体体积,应用VTQ技术测量腺体组织的剪切波速度值(SMV)。根据临床PTX指征,按照血清全段甲状旁腺激素(i PTH)、钙磷乘积以及增生腺体的体积大小分组,应用独立样本t检验比较不同组间增生腺体SMV的差异。并以SMV值绘制受试者操作特性(ROC)曲线。结果 33例检测到增大的甲状旁腺共59枚,检出率34%,VTQ技术显示增生腺体平均SMV值为(1.29±0.43)m/s。根据临床PTX指征分组,增生腺体的SMV值在单个腺体体积≥500 mm3组较大,为(1.75±0.59)m/s。SMV值区别增生腺体体积大小的最佳阈值为1.555 m/s,其ROC曲线下面积为0.794,敏感度79%,特异度76%。增生腺体的SMV值在钙磷乘积值≥4.52 mmol2/L2组较大,为(1.36±0.47)m/s。患者i PTH值对SMV值影响差异无统计学意义(P>0.05)。结论本组VTQ显示钙磷乘积大于正常水平及甲状旁腺腺体体积较大的患者增生腺体SMV值较大,可能对SHPT患者的PTX指征有一定帮助。

Objective To study the application value of virtual touch tissue quantification（VTQ） in parathyroid examination and parathyroidectomy of chronic renal failure patients with secondary hyperparathyroidism（SHPT）.Methods Ninety-five patients of renal failure with maintenance hemodialysis from October 2013 to June 2014 in Beijing Chaoyang Hospital of Capital Medical University were analyzed.Any diameter over 5 mm of one single gland was defined as hyperplasia gland.First,hyperplasia gland was examined,the size of gland was also calculated.Then VTQ was applied to measure the shear wave velocity（SMV） of hyperplasia gland.Parathyroid was grouped according to i PTH,calcium-phosphorus product and size of hyperplasia gland.A comparison of SMV among groups was conducted through Independent-Samples t test.ROC curve was performed by SMV results.Results Thirty-three cases with fifty-nine enlarged parathyroid were detected by conventional ultrasound examination.The detection rate was 34%.The average SMV of hyperplasia gland was（1.29±0.43） m/s,the SMV [（1.75±0.59） m/s] of hyperplasia gland was higher in the group which the volum of single gland was larger than 500 mm3.The best threshold of SMV to distinguish the size of hyperplasia parathyroid was 1.555 m/s,of which the area under the curve was 0.794,sensitivity was 79% and specificity was 76%.The SMV [（1.36±0.47） m/s] of hyperplasia gland was higher in the group which the calcium-phosphorus product was more than 4.52 mmol2/L2.The difference of the impact of i PTH to SMV was not statistically significant.Conclusions VTQ shows that both chronic renal failure patients with calcium-phosphorus product beyond the normal and patients with bigger parathyroid glands usually get the higher SMV results,which could provide help for the indications of parathyroidectomy of SHPT patients.