基于SPECT/CT甲状旁腺显像同机CT评估慢性肾脏病继发性甲状旁腺功能亢进症主动脉弓钙化的初步应用

Preliminary application of CT on accessing aortic arch calcification during parathyroid SPECT/CT in patients with renal secondary hyperparathyroidism

目的:探讨SPECT/CT甲状旁腺显像同机CT评估慢性肾脏病继发性甲状旁腺功能亢进症(SHPT)患者主动脉弓钙化(AoAC)的临床意义及危险因素。方法:回顾性分析2014年1月至2021年5月间在南通大学附属江阴医院行99Tc m-甲氧基异丁基异腈(MIBI)SPECT/CT显像的136例慢性肾脏病合并SHPT患者[男70例、女66例,年龄(50.1±11.4)岁],应用同机CT对AoAC评分(1~5分),分为无及轻度钙化组(AoAC评分<3分)及中重度钙化组(AoAC评分≥3分)。采用两独立样本t检验或Mann-Whitney U检验比较2组间各指标的差异;应用二元logistic回归分析AoAC的独立危险因素。结果:136例SHPT患者中有111例(81.62%)CT检出AoAC。无及轻度钙化组84例,中重度钙化组52例,2组的年龄[(46.7±9.8)和(55.7±11.6)岁;t=-4.84,P<0.001]、脉压[52(41,64)和60(51,70)mmHg(1 mmHg=0.133 kPa);z=-3.27,P=0.001]、血清校正钙[2.41(2.28,2.53)和(2.49±0.22)mmol/L;z=-2.50,P=0.013]、血磷[(1.95±0.39)和(2.14±0.48)mmol/L;t=-2.54,P=0.012]、钙磷乘积[(4.68±1.07)和(5.29±1.10)mmol^(2)/L^(2);t=-3.21,P=0.013]及甲状旁腺激素(PTH)[106.30(90.15,127.45)和109.90(87.93,157.63)pmol/L;z=-2.09,P=0.036]差异均有统计学意义。Logistic回归分析显示,血磷[比值比(OR)=7.261,95%CI:2.416~21.819,P<0.001],钙磷乘积(OR=1.598,95%CI:1.073~2.380,P=0.021)及PTH(OR=1.018,95%CI:1.007~1.029,P=0.001)是AoAC的独立危险因素。结论:SPECT/CT甲状旁腺显像同机CT可作为评估慢性肾脏病SHPT患者AoAC的有效方法,高血磷、高钙磷乘积及高PTH水平可能是AoAC的独立危险因素。

Objective To access the clinical value and related risk factors of aortic arch calcification(AoAC)in patients with renal secondary hyperparathyroidism(SHPT)on CT during parathyroid SPECT/CT imaging.Methods From January 2014 to May 2021,136 renal SHPT patients(70 males,66 females,age(50.1±11.4)years)who underwent parathyroid 99Tcm-methoxyisobutylisonitrile(MIBI)SPECT/CT in Affiliated Jiangyin Hospital of Nantong University were retrospectively enrolled.AoAC score was estimated with CT(1-5),and patients were divided into none-light AoAC group(AoAC score<3)and moderate-severe AoAC group(AoAC score≥3).Independent-sample t test or Mann-Whitney U test was used to compare differences of various indicators between two groups.Univariate binary logistic regression was used to analyze the influencing factors of AoAC.Results Of 136 renal SHPT patients,111(81.62%)were AoAC detected by CT.There were 84 patients in none-light AoAC group and 52 patients in moderate-severe AoAC group.The age((46.7±9.8)vs(55.7±11.6)years;t=-4.84,P<0.001),pulse pressure(52(41,64)vs 60(51,70)mmHg(1 mmHg=0.133 kPa);z=-3.27,P=0.001),serum corrected calcium(2.41(2.28,2.53)vs(2.49±0.22)mmol/L;z=-2.50,P=0.013),serum phosphorus((1.95±0.39)vs(2.14±0.48)mmol/L;t=-2.54,P=0.012),calcium phosphorus product((4.68±1.07)vs(5.29±1.10)mmol^(2)/L^(2);t=-3.21,P=0.013)and parathyroid hormone(PTH)level(106.30(90.15,127.45)vs 109.90(87.93,157.63)pmol/L;z=-2.09,P=0.036)between non-light AoAC group and moderate-severe AoAC group were significantly different.Logistic regression analysis showed that serum phosphorus(odds ratio(OR)=7.261,95%CI:2.416-21.819,P<0.001),calcium and phosphorus product(OR=1.598,95%CI:1.073-2.380,P=0.021)and PTH level(OR=1.018,95%CI:1.007-1.029,P=0.001)were independent risk factors of AoAC.Conclusions Hybrid SPECT/CT can be used for an effective method of evaluating AoAC in patients with renal SHPT.High serum phosphorus,high calcium phosphorus product and high PTH level may be independent risk factors of AoAC.