射频消融技术对甲状旁腺功能亢进患者甲状旁腺激素和血钙的短期影响

Short-term effects of radiofrequency ablation on PTH and blood Ca in patients with hyperparathyroidism

目的研究射频消融技术对甲状旁腺功能亢进患者甲状旁腺激素(PTH)和血钙(Ca)的短期影响。方法对47例病例进行回顾性分析,术前按照是否有基础疾病如糖尿病肾病、尿毒症等分为PHPT组和SHPT组。常规超声检查和核素扫描均可发现患者一侧或两侧均有1~4枚大小及数目不等的结节。检查并记录患者治疗前及治疗后短期内(消融后1 d)的PTH、血Ca的变化。结果PHPT组25例患者消融前后的PTH值分别为186.0(117.3,244.0)和11.6(6.8,40.0)pg/mL,血Ca分别为(2.66±0.26)和(2.32±0.22)mmol/L,差异均有统计学意义(P<0.05)。SHPT组22例患者消融前后的PTH值分别为1223.5(783.0,1559.0)和251.0(65.0,338.0)pg/mL,血Ca分别为(2.34±0.33)和(2.05±0.33)mmol/L,差异均有统计学意义(P<0.05)。PHPT和SHPT组间比较,PHPT组消融前后PTH差值远少于SHPT组消融前后差值,差异有统计学意义(P<0.05)。PHPT组消融前后血Ca差值大于SHPT组消融前后差值,但差异无统计学意义(P>0.05)。结论射频消融技术无论是对于原发性甲状旁腺功能亢进还是继发性甲状旁腺功能亢进都能够在短期内降低PTH和血Ca,且继发性甲状旁腺功能亢进PTH降低较原发性甲状旁腺功能亢进更明显。

Objective To study the short-term effects of radiofrequency ablation on parathyroid hormone(PTH)and blood Ca in patients with hyperparathyroidism.MethodssA total of 47 cases were retrospectively analyzed.They were divided into primary group and secondary group according to whether there were underlying diseases such as diabetic nephropathy or uremia.Conventional ultrasound and radionuclide scanning found 1-4 nodules of different sizes on one or both sides of the patient.The changes of PTH and blood Ca before and after treatment were examined and recorded.Results In PHPT group,before ablation the PTH value of 25 patients was 186.0(117.3,244.0)pg/mL,and the blood Ca value was(2.66±0.26)mmol/L;after ablation the PTH value was 11.6(6.8,40.0)pg/mL,and the blood Ca value was(2.32±0.22)mmol/L;with significant difference between them(P<0.05).The PTH value of 22 patients in SHPT group before and after ablation were 1223.5(283.0,1559.0)and 251.0(65.0,338.0),respectively;and the blood Ca were(2.34±0.33)mmol/L and(2.05±0.33)mmol/L,respectively.There were significant differences between them(P<0.05).The difference of PTH before and after PHPT ablation was significantly smaller than the dfference in SHPT group(P<0.05).The difference of blood Ca before and after PHPT ablation was greater than that in SHPT group(P>0.05).Conclusion Radiofrequency ablation can reduce PTH and blood Ca in a short time for both primary and secondary hyperparathyroidism,and the reduction of PTH in secondary hyperparathyroidism is more obvious than that in primary hyperparathyroidism.