常规超声评估继发性甲状旁腺功能亢进的严重程度

Conventional ultrasound in assessing severity of secondary hyperparathyroidism

目的采用常规超声评估继发性甲状旁腺功能亢进(SHPT)患者的严重程度。方法将50例甲状旁腺增生的SHPT患者按甲状旁腺激素(PTH)浓度分为4组:A组,PTH<250ng/L(n=8);B组,250ng/L≤PTH<600ng/L(n=12);C组,600ng/L≤PTH<800ng/L(n=18);D组,PTH≥800ng/L(n=12)。观察并比较4组甲状旁腺腺体的形态、大小、增生数目、内部回声及血供情况,对21例术后患者进行病理与超声结果对照。结果 4组间的超声表现差异有统计学意义(P均<0.05),随PTH浓度增高,甲状旁腺超声表现为形态更不规则,体积更大,内部回声不均匀,血供更丰富;超声表现存在一定交叉。C组和D组手术患者病理与超声表现符合率分别为66.67%(6/9)和100%(12/12)。结论超声检查可清晰显示甲状旁腺腺体的形态和血供特征,对评估SHPT的严重程度具有一定的临床价值,但超声表现存在一定的交叉,还需结合其他超声技术进一步提高评估SHPT严重程度的准确率。

Objective To assess the severity of secondary hyperparathyroidism（SHPT）with conventional ultrasound.Methods Fifty SHPT patients with parathyroid hyperplasia were divided into 4groups according to the parathyroid hormone（PTH）level（group A,PTH〈250ng/L,n=8;group B,250ng/L≤PTH〈600ng/L,n=12;group C,600ng/L≤PTH〈800ng/L,n=18;group D,PTH≥800ng/L,n=12）.The shape,size,number,internal echo and blood flow of parathyroid glands were observed and compared among the 4groups.The results of pathology of 21 patients underwent parathyroidectomy were corresponded with ultrasound features.Results The differences of ultrasound features among the4 groups were statistically significant（all P〈0.05）.With the increasing of PTH,the ultrasound features of parathyroid glands showed more irregular shape,larger volume,uneven internal echo and more abundant blood supply.But some ultrasound features had overlaps.The pathological accordant rates with the ultrasound features were 100%（12/12）in group D and 66.67%（6/9）in group C.Conclusion Ultrasound can clearly show the morphologic and blood supply features in parathyroid glands.It has clinical value in assessing the severity of SHPT.However,some ultrasound features have overlaps,so it is necessary to combine other ultrasound technologies to improve the accuracy in assessing the severity of SHPT.