B超引导下甲状旁腺内注射维生素D3对维生素D缺乏相关甲状旁腺功能亢进症患者钙磷代谢及肌肉功能的影响

Effect of ultrasound-guided intraparathyroid injection of vitamin D3 on calcium-phosphorus metabolism and muscle function of patients with hyperparathyroidism associated with Vitamin D deficiency and(or)insufficiency

目的:探讨B超引导下甲状旁腺内注射1,25双羟维生素D3[1,25(OH)_(2)D_(3)]对维生素D缺乏相关甲状旁腺功能亢进症患者钙磷代谢、肌肉功能的影响。方法:选取2020年1月至2022年6月于联勤保障部队第904医院肾脏内分泌科确诊为维生素D缺乏继发甲状旁腺功能亢进症的60例患者,按随机数表法将其分为观察组和对照组,每组30例。观察组患者给予B超引导下甲状旁腺内注射1,25(OH)_(2)D_(3)治疗,对照组患者给予口服1,25(OH)_(2)D_(3)治疗,于治疗前、治疗后2周观察两组患者超声影像图特征,检测钙磷水平、甲状旁腺素(PTH)、碱性磷酸酶(ALP),25羟维生素D(25OHD)、1,25(OH)_(2)D_(3)水平,以及24 h尿钙、尿磷水平,测量两组患者的骨骼肌力量和功能并进行对比分析。结果:两组患者治疗前,超声图像显示甲状腺左叶下极背侧低回声病灶,动脉期呈均匀高增强,治疗后,病灶动脉期无明显增强,呈“空洞”表现;观察组和对照组治疗后血钙水平分别为(2.06±0.11)mmol/L、(2.21±0.12)mmol/L,高于治疗前(1.92±0.02)mmol/L、(1.93±0.03)mmol/L,血磷水平分别为(0.92±0.11)mmol/L、(1.11±0.07)mmol/L,低于治疗前(1.24±0.02)mmol/L、(1.25±0.03)mmol/L,差异均有统计学意义(t=6.859、12.399、15.677、10.069,P<0.05),且观察组治疗后血钙、血磷水平均低于对照组,差异均有统计学意义(t=5.047、7.982,P<0.05);两组治疗后血PTH、ALP水平均低于治疗前,且观察组治疗后PTH、ALP水平均低于对照组,差异有统计学意义(t=28.125、12.605,P<0.05);两组治疗后血25OHD、1,25(OH)_(2)D_(3)及24 h的UCa水平均高于治疗前,24 h的UP水平均低于治疗前,且观察组治疗后血25OHD、1,25(OH)_(2)D_(3)及24 h的UCa高于对照组,24 h的UP水平低于对照组,差异有统计学意义(t=9.6763、5.269、45.086、3.387,P<0.05);两组治疗后L1~4、股骨颈骨密度值均高于治疗前,且观察组治疗后腰椎L1~4、股骨颈骨密度值均高于对照组,差异有统计学意义(t=26.944、2.355,P<0.05);两组治疗后骨骼肌握力、步速均高于治疗前,且观察组治疗后骨骼肌握力、步速均高于对照组,差异有统计学意义(t=2.711、3.093,P<0.05)。结论:维生素D缺乏相关甲状旁腺功能亢进症患者腺体出现钙化,超声表现为不同形状强回声。B超引导下甲状旁腺内注射1,25(OH)_(2)D_(3)可减少骨折的发生。

Objective:To explore the effect of intraparathyroid injection of 1,25 bishydroxyvitamin D3[1,25(OH)_(2)D_(3)]under the guidance of B-mode ultrasound on calcium-phosphorus metabolism and muscle function of patients with hyperparathyroidism associated with vitamin D deficiency and(or)insufficiency.Methods:A total of 60 patients with hyperparathyroidism associated with vitamin D deficiency and(or)insufficiency who were diagnosed at the 904th hospital of People’s Liberation Army Joint Service Support Force from January 2020 to June 2022 were selected,and they were divided into observation group and control group according to random number table,with 30 cases in each group.Patients in the observation group received intraparathyroid injection of 1,25(OH)_(2)D_(3),and those in the control group received oral 1,25(OH)_(2)D_(3).Before and after 2 weeks of treatment,the characteristics of ultrasound images of two groups were observed,and the calcium-phosphorus level,parathyroid hormone(PTH),alkaline phosphatase(ALP),25 hydroxyvitamin D(25 OHD),1,25(OH)_(2)D_(3),and urinary calcium(UCa)and urinary phosphorus(UP)at 24h of them were detected.In addition,the skeletal muscle strengths and functions of the two groups were measured.Results:Before treatment,ultrasound images showed the dorsal side of the inferior pole of left lobe of thyroid gland were hypoechoic lesion,and they appeared uniform high enhancement at the arterial phase.After treatment,there was no significant enhancement in the arterial phase of the lesion,which appeared"cavity".The blood calcium levels[(2.06±0.11)mmol/L and(2.21±0.12)mmol/L]of observation group and control group after treatment were significantly higher than those[(1.92±0.02)mmol/L and(1.93±0.03)mmol/L]before treatment,while the blood phosphorus levels[(0.92±0.11)mmol/L and(1.11±0.07)mmol/L]of them after treatment were significantly lower than those[(1.24±0.02)mmol/L and(1.25±0.03)mmol/L]before treatment,and the differences were significant(t=6.859,12.399,15.677,10.069,P<0.05),respectively.Both blood calcium level and blood phosphorus level after treatment of observation group were significantly lower than those of control group,and the differences were statistically significant(t=5.047,7.982,P<0.05),respectively.The PTH and ALP levels of two groups after treatment were significantly lower than those before treatment,and the PTH and ALP levels after treatment of observation group were significantly lower than those of control group,and the differences were statistically significant(t=28.125,12.605,P<0.05),respectively.The blood 25OHD,1,25(OH)_(2)D_(3)and UCa level at 24 h of two groups after treatment were significantly higher than those before treatment,while the UP level at 24-hour after treatment was lower than that before treatment.The blood 25OHD,1,25(OH)_(2)D_(3)and UCa at 24 h after treatment in observation group were significantly higher than those in control group,while the UP level at 24h after treatment in observation group was significantly lower than that in control group,with statistical significance(t=9.6763,5.269,45.086,3.387,P<0.05),respectively.The bone density values of L1-4 and femoral neck of two groups after treatment were significantly higher than those before treatment,and the bone density values of L1-4 and femoral neck after treatment in observation group were significantly higher than those in control group,with statistical significance(t=26.944,2.355,P<0.05).The grip strength and walking speed of the skeletal muscles of two groups after treatment were significantly higher than those before treatment,and the above indicators after treatment in the observation group were significantly higher than those in the control group,with statistical significance(t=2.711,3.093,P<0.05),respectively.Conclusion:There will be calcification in the gland of patient with hyperparathyroidism associated with vitamin D deficiency and(or)insufficiency,whose ultrasound appearance is strong echo with different shapes.B-mode ultrasound-guided intraparathyroid injection of 1,25(OH)_(2)D_(3)can reduce the incidence of fracture.