细针穿刺洗脱液甲状旁腺激素测定诊断原发性甲状旁腺功能亢进病灶的临床研究

Clinical study on the diagnosis of primary hyperparathyroidism lesions with parathyroid hormone assay in fine needle aspiration washout

目的探讨细针穿刺(FNA)洗脱液甲状旁腺激素(PTH)测定(FNA-PTH)对原发性甲状旁腺功能亢进病灶(HPTL)的诊断价值。方法选择2018年10月至2023年2月经颈部超声检出可疑甲状旁腺病变的患者,结合血PTH、核素显像、术后病理结果判定HPTL,分析FNA-PTH对HPTL的诊断效能,并构建合理的诊断切点。结果本研究共纳入94例患者、98个结节,其中76例患者(80个结节)接受了FNA检查。HPTL与非HPTL的FNA-PTH中位数分别为2396.50 pg/ml(Q1~Q3:878.08~5000.00 pg/ml)、21.98 pg/ml(16.04~32.16 pg/ml),FNA-PTH/血清PTH比值(PTH比值)中位数分别为12.47(4.89~29.43)、0.62(0.45~0.79),差异均有统计学意义(P值均<0.001)。ROC曲线显示FNA-PTH测值的AUC略高于PTH比值(0.937比0.849)。以187.90 pg/ml作为FNA-PTH的诊断界值时敏感性为88.9%,特异性与准确性均为90.9%,与PTH比值无统计学差异(P=1.0)。结论FNA-PTH检测对HPTL具有很高的定位与诊断价值,以187.90 pg/ml作为诊断切点效能最佳。

Objective To investigate the diagnostic value of parathyroid hormone measurement in fine needle aspiration washout(FNA-PTH)in primary hyperparathyroidism lesions(HPTLs).Methods Patients with suspected parathyroid lesions detected by neck ultrasonography from October 2018 to February 2023 were selected,and HPTL was determined based on serum parathyroid hormone(PTH),radionuclide imaging,and postoperative pathological results.The diagnostic value of FNA-PTH on HPTL was analyzed,and an effective diagnostic cut-off point was also established.Results A total of 94 patients and 98 nodules were enrolled in this study,of which 76 patients(80 nodules)underwent FNA.The median values of FNA-PTH for HPTLs and non-HPTLs were 2396.50 pg/ml(878.08-5000.00 pg/ml),21.98 pg/ml(16.04-32.16 pg/ml),and FNA-PTH/serum PTH(PTH ratio)were 12.47(4.89-29.43)and 0.62(0.45-0.79),respectively;the differences were statistically significant(all P<0.001).The ROC curve showed that the AUC of the FNA-PTH value was slightly higher than the PTH ratio(0.937 vs 0.849).Taking 187.90 pg/ml as the diagnostic cut-off value,the sensitivity,specificity,and accuracy of FNA-PTH were 88.9%,90.9%,and 90.0%,respectively.The efficacy was slightly better than the PTH ratio without statistical difference.Conclusions FNA-PTH testing is of great value in the localization and diagnosis of HPTL,with 187.90pg/ml as the optimal diagnostic cut-off.