机构地区:[1]南京医科大学第二附属医院医学影像科,江苏南京210000
出 处:《实用放射学杂志》2023年第4期561-565,共5页Journal of Practical Radiology
摘 要:目的探讨基于冠状动脉CT血管成像(CCTA)测得的左心房、左心耳结构和功能参数在评估继发性甲状旁腺功能亢进(SHPT)中的价值。方法回顾性分析行CCTA、左室射血分数(LVEF)>50%的120例SHPT患者资料,根据是否需要行甲状旁腺切除术(PTX)分为手术组(67例)和非手术组(53例),所有SHPT患者均行血全段甲状旁腺激素(iPTH)、血磷、血钙、甲状旁腺超声及超声心动图检查。采用图像后处理软件测得左心房最大容积(LAV_(max))、左心房最小容积(LAV_(min))及左心耳最大容积(LAAV_(max))、左心耳最小容积(LAAV_(min)),并计算左心房射血分数(LAEF)及左心耳射血分数(LAAEF)。采用独立样本t检验或χ^(2)检验比较2组各项指标的差异,通过二元logistic回归建立联合参数模型,通过受试者工作特征(ROC)曲线评估左心房参数及联合参数对是否行PTX的预测效能,采用Pearson相关分析左心房参数与iPTH之间的相关性。结果手术组的LAEF及LAAEF低于非手术组,差异有统计学意义(P<0.001)。LAEF及LAAEF的曲线下面积(AUC)、最佳阈值、诊断的灵敏度和特异度分别为0.833[95%置信区间(CI)0.798~0.928]、15.92%、66.21%、94.73%及0.846(95%CI0.826~0.945)、18.12%、74.01%、94.72%。LAEF联合LAAEF的AUC为0.916(95%CI0.889~0.980)。左心房功能参数LAEF及LAAEF与iPTH呈负相关(r=-0.438和-0.445,P<0.001)。结论CCTA左心房测量参数为评估SHPT患者是否需要行PTX提供了补充,为早期评估、早期干预SHPT患者治疗提供影像学量化指标。Objective To investigate the value of structural and functional parameters of left atrium and left atrial appendage measured on coronary CT angiography(CCTA)in evaluating secondary hyperparathyroidism(SHPT).MethodssTotally,120 SHPT subjects with left ventricular ejection fraction(LVEF)greater than 50%were all enrolled.All subjects underwent CCTA were analyzed retrospectively,and were divided into the surgical(67 subjects)and nonsurgical(53 subjects)groups according to whether the parathyroidectomy(PTX)was necessary.Intact parathyroid hormone(iPTH),phosphorus,calcium detection,parathyroid ultrasound and echocardiography examination were contacted in all SHPT subjects.The left atrium maximum volume(LAV_(max)),left atrium minimum volume(LAV_(min)),left atrial appendage maximum volume(LAAV_(max))and left atrial appendage minimum volume(LAAV_(min))were measured by post-processing software.Left atrium ejection fraction(LAEF)and left atrial appendage ejection fraction(LAAEF)were also calculated.Parameters between the two groups were compared by independent sample t test and Chi-square test.A combined parameter model was established through binary logistic regression and the predictive effects of left atrium parameters and combined parameters on whether to perform PTX were evaluated by receiver operating characteristic(ROC)curve.The correlations between left atrium parameters and iPTH were evaluated by Pearson correlation test.Results The LAEF and LAAEF of surgical group were significantly lower than those in nonsurgical group(P<0.001).The area under the curve(AUC)values,the cut-off values,the sensitivities and specificities of LAEF and LAAEF were O.833[95%confidence interval(CI)0.798-0.928],15.92%,66.21%,94.73%and0.846(95%CI0.826-0.945),18.12%,74.01%,94.72%respectively.The AUC value of LAEF combined LAAEF was 0.916(95%CI 0.889-0.980).Functional parameters of left atrium LAEF and LAAEF were negatively correlated with iPTH(r=-0.438 and-0.445,P<0.001).Conclusion Left atrium parameters measured on CCTA may be helpful in eva
关 键 词:慢性肾衰竭 继发性甲状旁腺功能亢进 甲状旁腺切除术 左心房 计算机体层成像
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