超声剪切波弹性成像模量值联合血钙及甲状旁腺激素诊断甲状旁腺腺瘤的价值  

Value of ultrasonic shear wave elastography combined with calcium and parathyroid hormone to the diagnosis of parathyroid adenoma

作　　者：冯晓蕾[1] 黄丽丽[1] 周琦[1] 姜珏[1] FENG Xiao-lei;HUANG Li-li;ZHOU Qi;JIANG Jue(Department of Medical Ultrasound,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an,Shaanri 710004,China)

机构地区：[1]西安交通大学第二附属医院超声研究室,陕西西安710004

出　　处：《中华实用诊断与治疗杂志》2022年第11期1157-1161,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金面上项目(81871366)。

摘　　要：目的 观察甲状旁腺腺瘤患者甲状旁腺超声剪切波弹性成像模量值及血钙、甲状旁腺激素(parathyroid hormone, PTH)水平变化,探讨各项指标联合鉴别诊断甲状旁腺腺瘤与甲状旁腺增生的价值。方法 甲状旁腺良性病变患者56例(74个肿块),均行手术治疗,术后组织病理诊断甲状旁腺腺瘤25例(25个肿块)为腺瘤组,诊断甲状旁腺增生31例(49个肿块)为增生组。2组术前均行超声检查,测量病灶直径、血流分级等,应用剪切波弹性成像技术测量甲状旁腺弹性模量最大值(maximum elastic modulus, E_(max))、弹性模量最小值(minimum elastic modulus, E_(min))、弹性模量均值(mean elastic modulus, E_(mean));术前检测血钙、血磷、PTH水平;绘制ROC曲线,评估病灶直径、病灶血流分级、血钙、PTH、E_(max)、E_(min)、E_(mean)单独及联合诊断甲状旁腺腺瘤的效能。结果 腺瘤组病灶直径[(13.09±4.53)mm]大于增生组[(8.02±3.69)mm](t=5.503,P<0.001),病灶血流≥Ⅱ级比率(64.0%)高于增生组(18.4%)(χ^(2)=21.438,P<0.001),病灶位置、回声、形态、边界清晰及合并钙化、囊性变比率与增生组比较差异均无统计学意义(P>0.05)。腺瘤组E_(max)[(26.73±5.71)kPa]、E_(min)[(20.80±4.83)kPa]、E_(mean)[(21.75±6.06)kPa]、血钙[(2.73±0.24)mmol/L]、PTH [(177.03±36.90)ng/L]水平均高于增生组[(22.56±3.39)kPa、(12.34±4.96)kPa、(16.61±3.89)kPa、(2.38±0.23)mmol/L、(105.41±21.97)ng/L](P<0.05),血磷水平与增生组比较差异无统计学意义(P>0.05)。病灶直径、E_(max)、E_(min)、E_(mean)、血钙、PTH最佳截断值分别为11.445 mm、25.96 kPa、16.435 kPa、20.535 kPa、2.565 mmol/L、121.345 ng/L,病灶血流为Ⅱ级,诊断甲状旁腺腺瘤的AUC分别为0.782(95%CI:0.664~0.900,P=0.023)、0.729(95%CI:0.591~0.867,P=0.020)、0.873(95%CI:0.792~0.953,P=0.008)、0.749(95%CI:0.626~0.872,P=0.022)、0.836(95%CI:0.746~0.927,P=0.010)、0.918(95%CI:0.857~0.933,P<0.001)、0.808(95%CI:0.707~0.904,P=0.016),灵敏度Objective To observe the changes of ultrasonic shear wave elastography value,calcium level and parathyroid hormone(PTH)level in patients with parathyroid adenoma,and to investigate the value of combined detection of them to the differential diagnosis of parathyroid adenoma and parathyroid hyperplasia.Methods Totally 74 masses in 56 patients with benign parathyroid diseases received parathyroid surgery,and were histopathologically confirmed as parathyroid adenoma in 25 masses(25 patients)(adenoma group)and parathyroid hyperplasia in 49 masses(31 patients)(hyperplasia group).Both two groups received two-dimensional ultrasound and shear wave elastography to measure the diameter of lesions and blood flow grade and to record the maximum elastic modulus (E_(max)),minimum elastic modulus (E_(min))and mean elastic modulus(E_(mean)).The levels of blood calcium,phosphorus and PTH were detected.ROC curves were drawn to evaluate the efficiencies of single and combined detection of the diameter of lesions,blood flow grade,blood calcium,PTH,E_(max),E_(min)and E_(mean)on the diagnosis of parathyroid adenoma.Results The diameter of lesions was greater in adenoma group[(13.09±4.53)mm]than that in hyperplasia group[(8.02±3.69)mm](t=5.503,P<0.001),the percentage of patients with blood flow grade≥Ⅱwas higher in adenoma group (64.0%)than that in hyperplasia group(18.4%)(χ^(2)=21.438,P<0.001),and there were no significant differences in the location,echo,shape,boundary and percentages of patients with calcification and cystic change between two groups (P>0.05).E_(max)[(26.73±5.71)kPa],E_(min)[(20.80±4.83)kPa],E_(mean)[(21.75±6.06)kPa],and the levels of calcium[(2.73±0.24)mmol/L]and PTH[(177.03±36.90)ng/L]in adenoma group were higher than those in hyperplasia group[(22.56±3.39)kPa,(12.34±4.96)kPa,(16.61±3.89)kPa,(2.38±0.23) mmol/L,(105.41±21.97)ng/L](P<0.05),and the blood phosphorus showed no significant difference between two groups(P>0.05).When the optimal cut-off values of the diameter of lesions,E_(max),E_(min),E_(

关 键 词：甲状旁腺腺瘤 甲状旁腺增生 超声 剪切波弹性成像 血钙 甲状旁腺激素 

分 类 号：R736.2[医药卫生—肿瘤]