99Tcm-MIBI SPECT/CT骨骼肌指数与肾性继发性甲状旁腺功能亢进患者甲状旁腺切除术后骨饥饿综合征的关系

Preliminary application of CT related skeletal muscle index during parathyroid 99Tcm-MIBI SPECT/CT on hungry bone syndrome in patients with renal secondary hyperparathyroidism after parathyroidectomy

目的探讨基于甲状旁腺99Tcm-甲氧基异丁基异腈(MIBI)单光子发射计算机断层扫描(SPECT)/CT测算的C3椎体中心层面相关CT骨骼肌指数(C3 SMI),与肾性继发性甲状旁腺功能亢进(SHPT)患者甲状旁腺切除术后(PTX)骨饥饿综合征(HBS)的关系。方法病例对照研究。纳入2015年6月—2024年4月南通大学附属江阴医院甲乳外科行PTX的88例肾性SHPT患者术前甲状旁腺99Tcm-MIBI SPECT/CT影像及临床资料,其中男49例、女39例,年龄26~74(51.1±10.1)岁。应用X-section软件测量C3椎体中心层面相关CT骨骼肌面积,由公式计算得到C3 SMI。根据术后是否发生HBS分为HBS组48例和非HBS组40例。观察指标:(1)纳入2组患者的年龄、性别、透析龄、体质量指数,实验室指标[血清白蛋白、碱性磷酸酶(ALP)、甲状旁腺激素(PTH)、血钙、血清校正钙、血磷、钙磷乘积],以及患者性别特异性的C3 SMI进行单因素分析。(2)将单因素分析差异有统计学意义的因素纳入多因素logistic回归分析HBS的独立危险因素。结果88例患者均顺利完成手术。49例男性患者C3 SMI为11.96~22.28(16.75±2.24)cm^(2)/m^(2),39例女性患者C3 SMI为8.45~17.94(13.53±2.03)cm^(2)/m^(2)。单因素分析结果显示,HBS组与非HBS组在年龄、ALP、PTH、血清校正钙及C3 SMI差异均有统计学意义(t=4.02、Z=-4.94、Z=-2.25、Z=-3.10、t=4.11;P值均<0.05)。多因素logistic回归分析显示:年龄(OR=0.93,95%CI:0.86~1.00)、ALP(OR=1.01,95%CI:1.00~1.02)、血清校正钙(OR=0.03,95%CI:0.00~0.87)及C3 SMI(OR=1.63,95%CI:1.16~2.29)为HBS的独立危险因素(P值均<0.05)。结论99Tcm-MIBI SPECT/CT骨骼肌指数C3 SMI是HBS的独立危险因素之一,可作为评估肾性SHPT患者PTX术后发生HBS的有效指标。

Objective This study aimed to assess the relationship of skeletal muscle index(C3 vertebral center related CT skeletal muscle index[C3 SMI])during 99Tcm-MIBI single-photon emission computed tomography(SPECT)/CT on hungry bone syndrome(HBS)in patients with renal secondary hyperparathyroidism(SHPT)after parathyroidectomy(PTX).Methods A case control study was conducted in Department of Thyroid and Breast Surgery,Affiliated Jiangyin Hospital of Nantong University from June 2015 to April 2024,examining 88 renal patients with SHPT(49 males and 39 females aged 26-74[51.1±10.1])and on parathyroid 99Tcm-MIBI SPECT/CT were enrolled.A total of 48 patients were included in the HBS group,and 40 patients in the non-HBS group.The indicators were as follows:(1)univariate analysis results for age,gender,dialysis duration,body mass index,laboratory parameters(serum albumin,alkaline phosphatase[ALP],parathyroid hormone[PTH],serum calcium,serum-corrected calcium,serum phosphorus,and calcium phosphorus product)and differences in the patient gender specification of 99Tcm-MIBI SPECT/CT skeletal muscle parameters skeletal muscle index[C3 SMI].(2)Factors with P<0.05 in univariate analysis were further analyzed through multivariate logistic regression.Results All the 88 patients underwent PTX successfully.The C3SMI of 49 male patients was 11.96-22.28(16.75±2.24)cm^(2)/m^(2).The C3SMI of 39 female patients was 8.45-17.94(13.53±2.03)cm^(2)/m^(2).Univariate analysis showed significant differences in age,ALP,PTH,serum-corrected calcium,and C3SMI between the HBS and non-HBS groups(t=4.02,Z=-4.94,Z=-2.25,Z=-3.10,t=4.11;all P values<0.05).Logistic regression analysis showed age(odds ratio[OR]=0.92,95%confidence interval[CI]:0.86-1.00),ALP(OR=1.01,95%CI:1.00-1.02),serum-corrected calcium(OR=0.03,95%CI:0.00-0.87),and C3 SMI(OR=1.63,95%CI:1.16-2.29)were independent risk factors for HBS(all P values<0.05).Conclusion 99Tcm-MIBI SPECT/CT skeletal muscle parameter C3 SMI is one of independent risk factors for HBS and is a potentially effective criterion for evaluating HBS in patients with renal SHPT after PTX.