继发性甲状旁腺功能亢进患者甲状旁腺99Tcm-MIBI显像与钙磷代谢相关性研究

摘要

目的:回顾性分析继发性甲状旁腺功能亢进(SHPT)患者甲状旁腺显像与血甲状旁腺激素(PTH)和钙磷代谢结果的关系.方法:选取125例临床确诊的SHPT患者,按常规方法行99Tcm-甲氧基异丁基异腈(99Tcm-MIBI)甲状旁腺双时相显像,采用视觉分析法统计阳性(高于周围组织)病例数、病灶数、病灶浓聚程度、病灶形态及病灶双期变化特点;收集显像前或显像后1个月内血PTH、钙和磷结果,采用IBM 22.0软件进行统计学分析.结果:72例99Tcm-MIBI显像阳性患者血PTH(999.1±943.1)pg/ml及血钙(2.5±0.3)mmol/L水平高于53例显像阴性患者(164.5±218.5)pg/ml,(2.4±0.2) mmol/L,血磷无差异.PTH>200 pg/ml患者中,99Tcm-MIBI显像阳性率为86.8%(46/53),PTH<100 pg/ml时,阳性率仅为19.5%(8/41).61.1%(44/72)患者病灶位于一侧,4例病灶位于甲状腺外.单发血PTH及血磷(708.4±802.5)pg/ml和(1.1±0.6)mmol/L明显低于双发(1208.9±934.6)pg/ml和(1.8±0.8)mmol/L及多发组(1559.5±1060.1)pg/ml和(1.9±0.8)mmol/L,双发及多发组间血PTH无差异,三组间血钙无差异.病灶对99Tcm-MIBI浓聚程度、浓聚形态及双期变化形式与血PTH、钙和磷无关.结论:核医学甲状旁腺显像对PTH>200 pg/ml的SHPT患者病灶诊断能力强.双期显像中任一期出现阳性病灶即可诊断功能亢进的甲状旁腺组织,需分次手术切除所有阳性病灶方可缓解症状,核医学甲状旁腺显像有助于术前定位.%Objective: To retrospectively analyze the correlation between 99Tcm-MIBI imaging of parathyroid gland and serum levels of parathyroid hormone(PTH), calcium-phosphorus metabolism in patients with secondary hyperparathyroidism(SHPT). Methods: 125 patients with SHPT(50 males, 75 females, 49.8±14.4 years old) were enrolled in the study. And all of them underwent routine 99Tcm-MIBI dual time phase scan for parathyroid gland. Depending on visual analysis, the number of positive cases, amount of lesions, gathering degree of lesions, morphological feature of lesions and the characteristics of change of lesions at dual phases were counted. And serum levels of parathyroid hormone(PTH) and the results of blood calcium and blood phosphorus at pre imaging or post imaging 1month were collected, and the IBM 22.0 software was applied to carry out statistical analysis. Results: The serum PTH(999.1±943.1)pg/ml and blood calcium(2.5±0.3) mmol/L of 72 patients with positive 99Tcm-MIBI imaging were higher than that of 53 patients with negative 99Tcm-MIBI imaging(164.5±218.5 pg/ml, 2.4±0.2 mmol/L). And there was no difference between the two groups at blood phosphate. When PTH more than 200 pg/mL, the positive rate of 99Tcm-MIBI imaging was 86.8%(46/53), and it only was 19.5%(8/41) when PTH less than 100 pg/mL. And the lesions of 61.1%(44/72) patients located at one side, and 4 lesions were beside thyroid gland. And the PTH and blood phosphate of single lesion group(708.4±802.5 pg/mL, 1.1±0.6 mmol/L) were obviously lower than that of dual lesions group (1208.9±934.6 pg/mL, 1.8±0.8 mmol/L) and multi lesions group(1559.5±1060.1 pg/mL, 1.9±0.8 mmol/L). And there was no difference between dual lesions group and multi lesions group at serum PTH, and there was no difference among three groups at blood calcium. Besides, gathering degree of lesions, morphological feature of lesions and change form of lesions at dual phases were not correlative with serum PTH, blood calcium and blood phosphate. Conclusion: The parathyroid gland imaging of nuclear medicine has strong diagnostic ability for the lesion of patients with SHPT when PTH more than 200 pg/mL. At dual time phase, if positive lesion occurred at anyone phase, the patients can be diagnosed as SHPT. For relieving symptoms, staged surgery should cut off all of positive lesion. Besides, the parathyroid gland imaging of nuclear medicine can contribute to achieve pre-surgery location of lesion.