静脉钙负荷甲状旁腺功能抑制实验的临床应用及安全性评价

Clinical Value and Safety Evaluation of Intravenous Calcium Suppression Test

目的探讨静脉钙负荷甲状旁腺功能抑制试验鉴别原发性、继发性甲状旁腺功能亢进症的临床应用及安全性评价。方法对疑似甲状旁腺功能亢进患者进行静脉钙负荷甲状旁腺功能抑制试验,共收集37例,以73%作为诊断切点,并参考甲状旁腺B超检查及病理结果,根据最后诊断分为原发性甲状旁腺功能亢进症(PHPT)、继发性甲状旁腺功能亢进症(SHPT)两组,其中PHPT组13例,SHPT组24例,比较两组间一般资料、生化指标、PTH抑制率(PTH-IR)等。结果 PHPT组血钙、碱性磷酸酶(ALP)明显高于SHPT组,PHPT组血磷、PTH-IR、PTH-IR/Δ血钙明显低于SHPT组;120min PTH-IR分别为PHPT(28.01±5.5)%,SHPT(79.1±4.2)%,两组间比较差异有统计学意义。结论静脉钙负荷甲状旁腺功能抑制试验对于鉴别PHPT及SHPT有一定的敏感度和特异性,且临床应用无不良反应,是一种行之有效的功能试验。

Objective To investigate the clinical value and safety evaluation of intravenous ealeium suppression test in the identifi- cation of primary and secondary hyperparathyroidism（HPT）. Methods A total of 37 patients with hyperparathyroidism were divided into two groups according to 73% as the cut - off value, parathyroid ultrasonography and pathological reports. Baseline data,biochemical indi- cator and the inhibition rate of PTH （ PTH - IR） were compared. Results In primary HPT （PHPT） group, serum calcium and ALP were significantly higher than secondary HPT（SHPT） group. Serum phosphorus, PTH - IR[ PTH - IR = （PTH level at 0rain - maximal PTH level）/PTH level at 0mini, PTH - IR/ACa（ maximal Ca level - Ca level at 0rain） were significantly smaller than SHPT group. There was significant difference in the PTH - IR among PHPT and SHPT. Conclusion Intravenous calcium suppression test is a kind of effective functional test and it has higher sensitivity and specificity in identification of PHPT and SHPT, and no adverse reaction in clinical applica- tion.