维持性血液透析继发性甲状旁腺功能亢进患者甲状旁腺增生超声临床特点及误诊原因分析  

Ultrasonographic Analysis of Clinical Characteristics and Causes of Misdiagnosis of Parathyroid Hyperplasia in Patients with Secondary Hyperparathyroidism Undergoing Maintenance Hemodialysis

作　　者：徐蓉[1] 田慧 吴迎春 吕康泰 XU Rong;TIAN Hui;WU Yingchun;LYU Kangtai(Department of Ultrasound Medicine,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China)

机构地区：[1]南京医科大学第二附属医院超声医学科,南京210011

出　　处：《临床误诊误治》2024年第10期16-22,共7页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨维持性血液透析继发性甲状旁腺功能亢进(SHPT)患者甲状旁腺增生超声临床特点及误诊原因。方法选择2021年4月至2023年2月维持性血液透析SHPT 190例为研究对象,比较不同程度SHPT患者超声特征,分析超声对SHPT患者甲状旁腺增生的诊断效能,多因素Logistic回归分析超声误诊的相关影响因素。再根据甲状旁腺是否增生分为增生组(n=127)和对照组(n=63),建立多因素Logistic回归模型分析SHPT患者甲状旁腺增生的独立危险因素,并分析不同方法对甲状旁腺增生的诊断效能。结果随SHPT严重程度的加重,多枚增生、低回声、结节形态不规则、结节血供丰富、内部回声不均匀、出现钙化的比例也随之升高。超声检查甲状旁腺增生的敏感度为0.881,特异度为0.657,误诊率为34.29%,漏诊率为11.86%。结节最大径、结节形态及结节血供均为超声误诊SHPT患者甲状旁腺增生的影响因素(P<0.05)。透析时间、碱性磷酸酶、血磷及甲状旁腺素水平是影响SHPT患者甲状旁腺增生的独立危险因素(P<0.01)。超声检查、Logistic回归模型及联合诊断甲状旁腺增生的受试者工作特征曲线下面积分别为0.773、0.754、0.889,其中联合诊断最高,并且准确性(0.840)和约登指数(0.679)均高于其他方法。结论随着维持性血液透析患者SHPT严重程度的加重,甲状旁腺形态结构改变越发显著,超声检查甲状旁腺增生误诊率较高,结节形态、结节最大径及结节血供对超声检查诊断结果具有显著影响。超声联合Logistic回归模型诊断SHPT患者甲状旁腺增生,具有较高价值。Objective To investigate the ultrasonographic characteristics and causes of misdiagnosis of parathyroid hyperplasia in patients with secondary hyperparathyroidism(SHPT)undergoing maintenance hemodialysis.Methods A total of 190 patients with SHPT undergoing maintenance hemodialysis from April 2021 to February 2023 were selected as the research subjects.The ultrasonographic characteristics of patients with SHPT of different degrees were compared,the diagnostic efficiency of ultrasound in patients with SHPT was analyzed,and the related influencing factors of ultrasound misdiagnosis were analyzed by multivariate Logistic regression.Then,according to whether the parathyroid hyperplasia was detected,they were divided into hyperplasia group(n=127)and control group(n=63).Multivariate Logistic regression model was established to analyze the independent risk factors of parathyroid hyperplasia in SHPT patients,and the diagnostic efficacy of different methods for parathyroid hyperplasia was analyzed.Results With the increase of the severity of SHPT,the proportion of multiple hyperplasia,low echo,irregular nodules,rich blood supply,uneven internal echo and calcification also increased.The sensitivity,specificity,misdiagnosis rate and missed diagnosis rate of ultrasonography were 0.881,0.657,34.29%and 11.86%,respectively.Nodule maximum diameter,nodule morphology and nodule blood supply were all influencing factors for ultrasound misdiagnosis of parathyroid hyperplasia in SHPT patients(P<0.05).Duration of dialysis,alkaline phosphatase,blood phosphorus and parathyroid hormone levels were independent risk factors for parathyroid hyperplasia in SHPT patients(P<0.01).The area under the receiver working characteristic(ROC)curve(AUC)of ultrasonography,Logistic regression model alone and in combination in the diagnosis of parathyroid hyperplasia were 0.773,0.754 and 0.889,respectively,among which the combined diagnosis was the highest,and the accuracy(0.840)and Jorden index(0.679)were higher than other methods.Conclusion With increase

关 键 词：维持性血液透析 甲状旁腺功能亢进 继发性 甲状旁腺素 超声检查 误诊 增生 危险因素 诊断 

分 类 号：R582.1[医药卫生—内分泌]