超声对慢性肾衰患者SHPT的筛查及术前评估

发布时间：2018-04-14 19:38

本文选题：超声 + 甲状旁腺功能亢进　；参考：《安徽医科大学学报》2017年12期

【摘要】：目的探讨彩色多普勒超声在肾衰维持透析患者继发性甲状旁腺增生筛查及甲状旁腺术前评估的价值。方法选取300例维持血液透析患者,分别记录患者透析龄、钙磷值及全段甲状旁腺激素(iPTH)含量,使用彩色多普勒超声评估甲状旁腺增生情况。另选择具有甲状旁腺全切加前臂自体移植手术适应证、并愿意接受手术治疗的患者25例,术前进行超声、核素扫描及CT等影像检查,以手术及病理为对照,对比分析各项检查术前评估甲状旁腺增生的准确性。同时观察患者手术前后生化指标及症状变化情况。结果在入组的患者中,iPTH及透析龄在甲状旁腺增生组和非甲状旁腺增生组的差异有统计学意义,甲状旁腺组患者iPTH显著高于非甲状旁腺增生组(P0.05),甲状旁腺增生组患者透析龄显著大于非甲状旁腺增生组(P0.05)。以手术病理为对照,超声、CT及核素扫描对于增生甲状旁腺的检出率分别为93.8%、40.0%及35.0%,超声对增生甲状旁腺检出率显著高于CT及核素扫描(P0.05)。结论在维持血液透析患者甲状旁腺增生的筛查中,iPTH及透析龄是极其重要的影响因素。与其他影像学比较,术前超声对甲状旁腺增生诊断准确性较高,可以作为临床常规筛查以及术前判断甲状旁腺增生数量、位置的可靠检查手段,核素扫描及CT/MRI可以作为特殊情况下评估有无异位甲状旁腺的必要补充。
[Abstract]:Objective to evaluate the value of color Doppler ultrasonography in the screening of secondary parathyroid hyperplasia and the preoperative evaluation of parathyroid gland in maintenance dialysis patients with renal failure.Methods 300 patients with hemodialysis were selected to record the age of dialysis, calcium and phosphorus and the content of whole parathyroid hormone iPTH.The hyperparathyroidism was evaluated by color Doppler ultrasound.In addition, 25 patients who had total parathyroid gland resection and autologous forearm transplantation were selected and were examined by ultrasound, radionuclide scan and CT before operation, and compared with operation and pathology.The accuracy of preoperative assessment of parathyroid hyperplasia was compared and analyzed.At the same time, the changes of biochemical indexes and symptoms before and after operation were observed.Results there were significant differences in iPTH and dialysis age between parathyroid hyperplasia group and non-parathyroid hyperplasia group.The iPTH of parathyroid hyperplasia group was significantly higher than that of non-parathyroid hyperplasia group (P 0.05), and the dialysis age of parathyroid hyperplasia group was significantly longer than that of non parathyroid hyperplasia group (P 0.05).The detectable rate of hyperplastic parathyroid gland was 93.8% and 35.0% respectively by ultrasonography and radionuclide scanning. The detection rate of hyperplastic parathyroid gland by ultrasound was significantly higher than that of CT and radionuclide scan (P 0.05).Conclusion iPTH and dialysis age are very important factors in the screening of parathyroid hyperplasia in hemodialysis patients.Compared with other imaging images, the accuracy of preoperative ultrasonography in the diagnosis of parathyroid hyperplasia was higher, and it could be used as a reliable means for clinical routine screening and for judging the quantity and location of parathyroid hyperplasia before operation.Radionuclide scanning and CT/MRI can be used as a necessary supplement to evaluate the presence of ectopic parathyroid glands.
【作者单位】：安徽医科大学第一附属医院超声科;
【基金】：安徽省自然科学基金(编号:1308085MH155)
【分类号】：R445.1;R692.5

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