临床-超声视觉征象模型评估继发性甲状旁腺功能亢进严重程度的应用研究  

Application of clinical and ultrasound-based model in evaluating the severity of secondary hyperparathyroidism

作　　者：许文欣 张晓儿 林晋华 林满霞[1] 黄光亮[1] 谢晓燕[1] 徐明[1] Xu Wenxin;Zhang Xiaoer;Lin Jinhua;Lin Manxia;Huang Guangliang;Xie Xiaoyan;Xu Ming(Institute of Diagnostic and Interventional Ultrasound,Sun Yat-Sen University&Department of Ultrasound,the First Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院超声医学科,中山大学超声诊断与介入超声研究所,广州510080

出　　处：《中华超声影像学杂志》2021年第12期1052-1057,共6页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金面上项目(82071951)。

摘　　要：目的分析继发性甲状旁腺功能亢进(SHPT)患者灰阶超声及超声造影特点,并建立临床-超声视觉征象模型,探讨该模型与全段甲状旁腺素(intact parathyroid hormone,iPTH)的相关性,寻找评估SHPT严重程度的指标。方法纳入2016年1月至2021年3月因SHPT于中山大学附属第一医院就诊的SHPT患者59例,共181个病灶,患者均接受灰阶超声和超声造影检查,并根据iPTH水平分为低iPTH组(iPTH<800 ng/L)和高iPTH组(iPTH≥800 ng/L)。由2名医师分析每个甲状旁腺腺体灰阶超声及超声造影特点,并联合血清学指标等临床特征,建立临床-超声视觉征象模型,采用多元线性回归分析该模型与iPTH的相关性,探讨未经药物治疗的SHPT患者iPTH水平的独立影响因素。结果低iPTH组19例,高iPTH组40例。两组间血钙、血磷、血肌酐水平、病灶个数、病灶总体积、血供得分、钙化/囊性变得分、超声造影得分差异有统计学意义(均P<0.05)。多元线性回归分析显示,血磷水平、病灶总体积、血供得分为血清iPTH水平的独立影响因素(标准系数分别为0.387、0.254、0.242,均P<0.05)。结论血磷水平、病灶总体积、血供情况是iPTH水平的独立影响因素,超声影像特征结合临床指标可准确地评估SHPT严重程度。Objective To analyze the gray-scale ultrasound and contrast-enhanced ultrasound features in secondary hyperparathyroidism(SHPT)to construct a clinical and ultrasound-based model,and to investigate the relationship between this model and serum intact parathyroid hormone(iPTH)level in order to find proper indicators for evaluation of the severity of SHPT.Methods From February 2016 to March 2021,a total of 59 SHPT patients with 181 parathyroid glands(PTGs)admitted to the First Affiliated Hospital of Sun Yat-Sen University were enrolled.Gray-scale ultrasound and contrast-enhanced ultrasound were performed in every participant.Patients were divided into low-iPTH group(iPTH<800 ng/L)and high-iPTH group(iPTH≥800 ng/L)according to the serum iPTH level.The characteristics of gray-scale ultrasonic imaging and contrast-enhanced ultrasonic imaging were analyzed by 2 sonographers.Biochemical parameters were collected and combined with ultrasonic characteristics to construct the clinical and ultrasound-based model.The relationship between the model and serum iPTH level was analyzed by multivariate linear regression(stepwise).Independent influencing factors on serum iPTH level was investigated in SHPT patients without iPTH-reducing drugs using history.Results There were 19 patients in low-iPTH group and 40 patients in high-iPTH group.Serum calcium,serum phosphorus,serum creatinine,PTG number,total PTG volume,blood scores,calcification and cysts scores,CEUS scores(washing-in phase and washing-out phase)were significantly different between two groups(all P<0.05).The multivariate linear regression(stepwise)showed that serum phosphorus,total PTG volume and blood scores were independently related with serum iPTH level(standardizedβcoefficient were 0.387,0.254 and 0.242 respectively;all P<0.05).Conclusions Serum phosphorus,total PTG volume and blood scores are independent influencing factors on serum iPTH level.Ultrasonography combined with clinical parameters can help evaluate the severity of SHPT more accurately.

关 键 词：临床-超声视觉征象模型 继发性甲状旁腺功能亢进 灰阶超声 超声造影 全段甲状旁腺素 

分 类 号：R582.1[医药卫生—内分泌]