甲状旁腺素在原发性醛固酮增多症分型诊断中的价值

Value of parathyroid hormone in classification diagnosis of primary aldosteronism

目的探讨原发性醛固酮增多症(PA)中的醛固酮瘤(APA)、特发性醛固酮增多症(IHA)患者与肾上腺无功能瘤或结节(NFAT)患者的血清甲状旁腺素(PTH)水平变化,以及影响PTH水平变化的因素。方法分析该院2012年1月至2018年12月诊断的PA患者(其中APA 9例、IHA 10例)及NFAT患者(10例)的临床资料,比较不同类型PA中APA、IHA患者和NFAT患者PTH、血钾、血钙、尿钾、尿钙、醛固酮等生化指标的变化。采用Pearson相关分析探讨影响PTH水平变化的因素。结果与NFAT患者相比,APA、IHA患者中PTH、尿钾、醛固酮水平升高(P<0.05),血钾、血钙水平下降(P<0.05),尿钙水平差异无统计学意义(P>0.05)。Pearson相关分析显示,PTH水平与血钾、血钙水呈负相关(r=-0.646、-0.465,P<0.05),与尿钾、尿钙、醛固酮呈正相关(r=0.548、0.589、0.455,P<0.05)。受试者工作特征曲线分析显示,PTH鉴别诊断PA与NFAT的最佳切点值为64.4 pg/mL,灵敏度为88.9%,特异度为80.0%;PTH鉴别诊断APA与IHA的最佳切点值为86.8 pg/mL,灵敏度为77.8%,特异度为78.0%。结论不同类型PA患者血清PTH变化不同,PTH在PA分型诊断中具有临床意义。

Objective To investigate the changes of parathyroid hormone(PTH)in the cases of aldosterone-producing adenoma(APA)and cases of idiopathic aldosteronism(IHA)among the primary aldosteronism(PA)patients and the patients with adrenal gland non-functional tumor or nodule(NFAT),and to explore the factors affecting the PTH level change.Methods The clinical data in the PA patients(9 cases of APA and 10 cases of IHA)and the NFAT patients(10 cases)in this hospital from January 2012 to December 2018 were analyzed.The changes of biochemical indicators such as PTH,blood potassium,calcium,urine potassium,urine calcium and aldosterone were compared among APA,IHA patients in different types of PA and NFAT patients.The Pearson correlation analysis was adopted to investigate the factors affecting the PTH level.Results Compared with the NFAT cases,the levels of PTH,urine potassium and aldosterone in the cases of APA and IHA were elevated,while the levels of blood potassium and calcium were decreased(P<0.05).The urine calsium level had no statistical difference(P>0.05).The Pearson correlation analysis showed that the PTH level was negatively correlated with the levels of blood potassium and calcium in the patients with PA(r=-0.646,-0.465,P<0.05),and positively correlated with urine potassium,calsium and aldosterone(r=0.548,0.589,0.455,P<0.05).The receiver operating characteristic(ROC)curve analysis showed that the cut-off point of PTH for differential diagnosing PA and NFAT was 64.4 pg/mL,the sensitivity was 88.9%and the specificity was 80.0%,which of PTH for differential diagnosing APA and IHA was 86.8 pg/mL,the sensitivity was 77.8%and the specificity was 78.0%.Conclusion The serum PTH level is different in different types of PA,which has the clinical significance in the classification diagnosis of PA.