甲状旁腺功能亢进症患者甲状旁腺激素测定与^99Tc^m-MIBI显像  

Parathyroid hormone measurement and ^99Tc^m-MIBI imaging for hyperparathyroidism diagnosis

作　　者：赵赟赟[1] 王茜[1] 李原[1] 岳明纲[1] 李河北[1] 

机构地区：[1]北京大学人民医院核医学科,100044

出　　处：《中华核医学杂志》2011年第4期263-266,共4页Chinese Journal of Nuclear Medicine

摘　　要：目的评价原发性甲状旁腺功能亢进症（简称甲旁亢）诊断中^99Tc^m-MIBI显像与血清全段PTH测定结果间的关系。方法对70例临床疑诊甲旁亢患者行血清全段PTH测定和^99Tc^m-MIBI显像。血清PTH〉88ng／L为诊断甲旁亢依据；^99Tc^m-MIBI显像以早期相发现且延迟相显示相对清晰的异常放射性浓聚灶为病变腺体的检出依据。对照最终临床诊断结果，评价鲫Tcm_MIBI显像对病变甲状旁腺的检出效能及与血清PTH检测结果的关系；并以Pearson直线相关分析法分析血清PTH水平与病变腺体体积之间的相关性。结果70例患者中最终证实为甲旁亢者38例。^99Tc^m-MIBI显像对70例患者的诊断准确性为90．0％（63／70）；在PTH正常组为80．0％（12／15），在PTH升高组为92．7％（51／55）；假阳性均见于PTH正常者。若^99Tc^m-MIBI显像诊断甲状旁腺病变以PTH升高为前提，则总体诊断准确性为94．3％（66／70）；Pearson直线相关分析显示，原发性甲旁亢患者血清PTH水平与病变腺体体积之间呈正相关（r=0．782，P〈0．001）。结论甲状旁腺病变腺体行^99Tc^m-MIBI显像时应先测定血清PTH，以提高^99Tc^m-MIBI显像的诊断准确性。Objective To evaluate 99Tcm-MIBI imaging in patients with hyperparathyroidism and its correlation with serum intact PTH level. Methods Seventy patients with suspicious hyperparathyroidism underwent 99Tcm-MIBI imaging and serum intact PTH measurement. Abnormal increased uptake lesion appeared at early phase and even more clearly at delayed phase was considered as the positive by 99Tcm-MIBI imaging. A cnt-off value of PTH 〉 88 ng/L was taken as the criteria for hyperparathyroidism diagnosis. The diagnostic efficacy of 99Tcm-MIBI imaging combined with serum PTH measurement was assessed according to post-surgical histopathology or clinical follow-up. For those operated patients, Pearson correlation coefficient between serum PTH and the gland volume was calculated. Results Hyperparathyroidism was confirmed in 38 patients by histopathology （n = 36） or follow-up （n = 2 ）. The overall diagnostic accuracy of ~ Tem-MIBI imaging was 90.0% （63/70）, in which the accuracy was 80.0% （12/15） for patients with normal serum PTH and 92.7% （51/55） for those with elevated serum PTH. False positive 99Tcm-MIBI imaging were found in 3 patients with normal serum PTH. The diagnostic accuracy of abnormally high serum PTH combined with 99Tcm-MIBI imaging was 94.3% （66/70）. There was a positive correlation between serum PTH level and the volume of pathologic parathyroid glands （r=0.782, P〈0.001）. Conclusions Serum PTH measurement may help to improve the diagnostic accuracy of 99Tcm-MIBI imaging in patients with hyperparathyroidism.

关 键 词：甲状旁腺功能亢进症 甲状旁腺激素类 放射性核素显像 MIBI 

分 类 号：R692.5[医药卫生—泌尿科学]