自体荧光基点光谱分析联合免疫胶体金技术在继发性甲旁亢术中识别异位微型旁腺的临床探索  

Clinical research of near-infrared autofluorescence point-spectral analysis combined with immune colloidal gold technique for identification of ectopic micro-parathyroid glands during surgery of secondary hyperparathyroidism

作　　者：彭琨 陈宏存[1,2] 姚宝忠[1,2] 宋伟涛 李良[1,2] PENG Kun;CHEN Hongcun;YAO Baozhong;SONG Weitao;LI Liang(Department of Thyroid and Breast Surgery,Hefei Second People's Hospital Affiliated to Bengbu Medical University,Hefei 230011,Anhui,China;Department of Thyroid and Breast Surgery,Hefei Second People's Hospital,Hefei 230011,Anhui,China)

机构地区：[1]蚌埠医科大学附属合肥市第二人民医院甲乳外科,安徽合肥230011 [2]合肥市第二人民医院甲乳外科,安徽合肥230011

出　　处：《中国现代手术学杂志》2024年第4期275-282,共8页Chinese Journal of Modern Operative Surgery

基　　金：合肥市卫生健康委应用医学科研项目(Hwk2023zc011);蚌埠医科大学自然科学类项目(2022byzd210);合肥市第二人民医院院级科研项目(2022yzd004)。

摘　　要：目的研究近红外自体荧光基点光谱分析(near-infrared autofluorescence point-spectral analysis,NIAPSA)联合免疫胶体金技术(immune colloidal gold technique,ICGT)在继发性甲状旁腺功能亢进(secondary hyperparathyroid,SHPT)术中识别异位微型旁腺组织并指导手术切除的效果。方法回顾性分析2021年10月至2022年9月手术治疗的34例SHPT患者的临床资料。术中于双侧颈中央区使用NIAPSA探测分析,结合肉眼辨认后以注射器针头穿刺取洗脱稀释液行ICGT检测。联合检测为阴性者仅全切正常解剖位置腺体,阳性者加行阳性侧颈中央区纤维脂肪组织廓清术。分析联合检测的识别效果、相关生化指标、术后临床症状转归、甲状腺功能与骨代谢情况。结果本组34例手术均成功,其中经NIAPSA联合ICGT检测后行甲状旁腺廓清术(clean parathyroidectomy,CPTX)8例,仅行甲状旁腺全切术(total parathyroidectomy,TPTX)26例;共切除甲状旁腺143枚,其中正常位置134枚(显著增生),异位9枚(4枚轻度增生,5枚未见明显增生)。本组颈中央区纤维脂肪组织内NIAPSA探测阳性共10例12处,联合ICGT识别阳性病例8例共9份样本,联合检测阳性的廓清样本经术后病理证实均为异位旁腺。NIAPSA阳性样本预测值为75.0%,阳性病例预测值为80.0%,NIAPSA联合ICGT阳性预测值为100%。术前、术后1 d、3 d、术后1周及1月、3月、6月甲状旁腺激素(parathyroid hormone,PTH)、血钙、血磷、钙磷乘积(calcium-phosphorus product,CPP)、碱性磷酸酶(alkaline phosphatase,ALP)比较均有统计学差异(P<0.001)。PTH、血钙、血磷及CPP术后各时段均较术前明显改善,ALP自术后1周始至术后6月较术前改善(P<0.05)。PTH、血钙和CPP于术后1 d降至最低,血磷于术后1月降至最低,此后逐渐升高趋于正常;ALP自围术期开始向中远期缓慢降低。术后患者关节骨痛、皮肤瘙痒、肌无力症状明显改善,且随着时间的延长,术后各时间段有症状�Objective To explore the clinical effect of near-infrared autofluorescence point-spectral analysis(NIAPSA)combined with immune colloidal gold technique(ICGT)to identify ectopic micro-parathyroid tissue,and guide surgical resection in the surgery of secondary hyperparathyroidism(SHPT).Methods The clinical data of 34 SHPT patients treated surgically from October 2021 to September 2022 were retrospectively studied.During the surgery,NIAPSA detection analysis combination with visual identification was used in the central region of bilateral neck,and followed by ICGT testing of elution dilution obtained by syringe needle puncture.According to combined test outcome,the surgical procedure was determined:Only the normal anatomical position of the gland was completely excised for the patients with negative outcome,and fibroadipose tissue dissection was combined in the central region of the neck for the patients with positive test.The effect of combined detection,related biochemical indexes,improvement of clinical symptom,thyroid function and bone metabolism were analyzed.Results The surgery was successful in all 34 cases,including 26 of total parathyroidectomy(TPTX)and 8 of additional clean parathyroidectomy(CPTX).A total of 143 parathyroid glands were removed,of which 134 were in normal position(with significant hyperplasia)and 9 were ectopic(with 4 of mild hyperplasia and 5 of non-significant hyperplasia).The NIAPSA detection was positive in 10 cases with 12 focuses,combined with ICGT test was positive in 8 cases with 9 samples,and the clearance samples with positive outcome of combined detection was confirmed to be ectopic parathyroid by postoperative pathology.The predictive value of NIAPSA positive samples,positive cases and NIAPSA combined with ICGT was 75.0%,80.0%and 100%respectively.There were statistically significant differences in parathyroid hormone(PTH),serum calcium,serum phosphorus,calcium-phosphorus product(CPP)and alkaline phosphatase(ALP)level before surgery,1-and 3 d,1 week,1-,3-and 6 months after surge

关 键 词：继发性甲状旁腺功能亢进 异位甲状旁腺 甲状旁腺激素 近红外自体荧光显像 基点光谱分析 免疫胶体金层析法 

分 类 号：R653[医药卫生—外科学]