^(99)Tc^(m)-MIBI甲状旁腺显像与血清PTH在原发性甲状旁腺功能亢进症中的诊断价值

Diagnostic value of ^(99)Tc^(m) MIBI parathyroid imaging and serum PTH in primary hyperparathyroidism

目的研究^(99)Tc^(m)-甲氧基异丁基异腈(^(99)Tc^(m)-MIBI)甲状旁腺显像与血清甲状旁腺素(PTH)在原发性甲状旁腺功能亢进症中的诊断价值。方法纳入2019年1月至2022年1月河南科技大学附属黄河三门峡医院收治的90例疑似原发性甲状旁腺功能亢进症患者为研究对象,所有患者入院时均行^(99)Tc^(m)-MIBI双时相延迟显像及血清PTH检测。以患者病理诊断结果为金标准,分析^(99)Tc^(m)-MIBI双时相延迟显像和血清PTH单一及联合诊断原发性甲状旁腺功能亢进症的价值。结果90例原发性甲状旁腺功能亢进症患者中,经病理检查证实为原发性甲状旁腺功能亢进症者56例,非原发性甲状旁腺功能亢进症者34例。血清PTH检测结果显示,原发性甲状旁腺功能亢进症血清PTH显著高于非原发性甲状旁腺功能亢进症患者,差异有统计学意义(P<0.05)。经ROC曲线处理,显示血清PTH对原发性甲状旁腺功能亢进症具有一定诊断价值,曲线下面积为0.776,标准误0.051,95%CI:0.677~0.875,最佳截断值136.92 pg/mL,敏感度0.789,特异度0.754。^(99)Tc^(m)-MIBI双时相延迟显像判为阳性57例,阴性33例,^(99)Tc^(m)-MIBI诊断原发性甲状旁腺功能亢进症的敏感度为0.893,特异度0.794,准确率0.856,阳性预测值0.877,阴性预测值0.818,Kappa值0.691。^(99)Tc^(m)-MIBI甲状旁腺显像联合血清PTH诊断原发性甲状旁腺功能亢进症的灵敏度为0.964,特异度0.912,准确率0.944,阳性预测值0.947,阴性预测值0.939,Kappa值0.881。结论^(99)Tc^(m)-MIBI甲状旁腺显像及血清PTH对原发性甲状旁腺功能亢进症均有一定诊断价值,联合二者可显著提高诊断效能。

Objective To study the diagnostic value of ^(99)Tc^(m) MIBI parathyroid imaging and serum parathyroid hormone(PTH)in primary hyperparathyroidism.Methods Ninety patients with suspected primary hyperparathyroidism treated in our hospital from January 2019 to January 2022 were included as the research objects.All patients underwent ^(99)Tc^(m) MIBI dual phase delayed imaging and serum PTH detection at admission.The value of ^(99)Tc^(m) MIBI dual phase delayed imaging and serum PTH in the diagnosis of primary hyperparathyroidism was analyzed.Results Among 90 patients with suspected primary hyperparathyroidism,56 cases were confirmed as primary hyperparathyroidism by pathological examination,and 34 cases were non primary hyperparathyroidism.The results of serum PTH test showed that serum PTH in patients with primary hyperparathyroidism was significantly higher than that in patients with non primary hyperparathyroidism(P<0.05).The ROC curve showed that serum PTH had certain diagnostic value for primary hyperparathyroidism.The area under the curve was 0.776,the standard error was 0.051,95%CI:0.677-0.875,the best cut-off value was 136.92 pg/mL,the sensitivity was 0.789 and the specificity was 0.754.The sensitivity,specificity,accuracy,positive predictive value,negative predictive value and Kappa value of ^(99)Tc^(m) MIBI in the diagnosis of primary hyperparathyroidism were 0.893,0.794,0.856,0.877,0.818 and 0.691,respectively.The sensitivity,specificity,accuracy,positive predictive value,negative predictive value,Kappa value of ^(99)Tc^(m) MIBI parathyroid imaging combined with serum PTH in the diagnosis of primary hyperparathyroidism were 0.964,0.912,0.944,0.947,0.939,and 0.881,respectively.Conclusion ^(99)Tc^(m) MIBI parathyroid imaging and serum PTH have certain diagnostic value in primary hyperparathyroidism.The combination of them can significantly improve the diagnostic efficiency.