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  • 刘奕宸,黄冬妮,李慧娟,等.血清PTH、钙和磷联合预测99mTc-MIBI SPECT/CT显像阳性甲状旁腺占位的回顾性研究[J].同济大学学报(医学版),2023,44(2):237-245.    [点击复制]
  • LIU Yichen,HUANG Dongni,LI Huijuan,et al.Serum parathyroid hormone, corrected calcium and phosphorus levels for predicting positive results of 99mTc-MIBI SPECT/CT imaging in primary hyperparathyroidism[J].同济大学学报(医学版),2023,44(2):237-245.   [点击复制]
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血清PTH、钙和磷联合预测99mTc-MIBI SPECT/CT显像阳性甲状旁腺占位的回顾性研究
刘奕宸,黄冬妮,李慧娟,丁慧茹,韩东旭,王宇,宋利格
0
(同济大学医学院,上海200092;同济大学附属同济医院内分泌代谢科,上海200065)
摘要:
目的甲状旁腺99mTc-甲氧基异丁基异腈(methoxyisobutyl isonitrile, MIBI)SPECT/CT显像是原发性甲状旁腺功能亢进症(primary hyperparathyroidism, PHPT)的重要定位诊断方法,在PHPT的诊治中具有重要价值,但该诊疗设备尚不普及且对专业人员要求较高。本研究探索联合血清甲状旁腺激素(parathyroid hormone, PTH)、血清校正钙(corrected calcium, corrected Ca)和血清磷(phosphorus, P)水平在预测99mTc-MIBI SPECT/CT显像阳性甲状旁腺占位中的价值,为PHPT的诊断提供更普遍实用的临床诊断方法。方法回顾性分析2014年6月—2021年12月在同济大学附属同济医院就诊的疑似PHPT患者,符合入选标准和排除标准后,收集103名患者的基线临床资料、血常规、生化指标、肝肾功能、甲状腺功能、糖脂代谢相关指标、骨转换相关指标及甲状旁腺99mTc-MIBI SPECT/CT显像结果。依据99mTc-MIBI SPECT/CT显像结果将患者分为MIBI阳性组和MIBI阴性组。分析生化指标与甲状旁腺99mTc-MIBI SPECT/CT显像结果的相关性以及显像结果的影响因素。以受试者工作特征(ROC)曲线分析血清PTH、校正钙和磷单一指标和三者联合预测99mTc-MIBI SPECT/CT显像阳性甲状旁腺占位的价值。应用Logistic分析判别得出99mTc-MIBI SPECT/CT显像阳性的预测模型。结果MIBI阳性组患者的血清PTH(P=0.022)、校正钙(P<0.001)水平明显高于MIBI阴性组,磷(P=0.020)水平明显低于MIBI阴性组。Spearman相关性分析得出,血清PTH(P=0.021)、校正钙(P<0.001)与99mTc-MIBI SPECT/CT显像阳性结果呈正相关,磷(P=0.025)与99mTc-MIBI SPECT/CT显像阳性结果呈负相关。将患者血清PTH、校正钙和磷作为自变量,99mTc-MIBI SPECT/CT显像结果作为因变量,行Logistic回归分析,血清校正钙为99mTc-MIBI SPECT/CT阳性显像的独立影响因素(OR: 21.96,95%CI: 2.829~170.530,P=0.003)。PTH、校正钙、磷联合预测99mTc-MIBI SPECT/CT显像结果的曲线下面积(AUC)为0.748(95%CI: 0.651~0.845)。结论联合血清PTH、校正钙和磷水平预测99mTc-MIBI SPECT/CT显像结果,筛选拟行99mTc-MIBI SPECT/CT显像的患者,对PHPT的诊断具有重要的临床应用价值。
关键词:  甲状旁腺素  校正钙    99mTc-MIBI SPECT/CT  原发性甲状旁腺功能亢进症
DOI:10.12289/j.issn.1008-0392.22437
投稿时间:2022-11-07
基金项目:上海市科学技术委员会项目(22Y11904600)
Serum parathyroid hormone, corrected calcium and phosphorus levels for predicting positive results of 99mTc-MIBI SPECT/CT imaging in primary hyperparathyroidism
LIU Yichen,HUANG Dongni,LI Huijuan,DING Huiru,HAN Dongxu,WANG Yu,SONG Lige
(School of Medicine, Tongji University, Shanghai 200092, China; Department of Endocrinology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China)
Abstract:
ObjectiveTo evaluate the application of serum parathyroid hormone(PTH), corrected calcium(Ca) and phosphorus(P) levels for predicting positive results of 99mTc-MIBI SPECT/CT imaging in primary hyperparathyroidism(PHPT). MethodsClinical and imaging data of 103 patients with suspected PHPT who underwent 99mTc-MIBI SPECT/CT scans in Tongji Hospital Affiliated to Tongji University from June 2014 to December 2021 were analyzed retrospectively. Complete blood count, blood biochemistry indexes, liver and kidney function, thyroid function, glucose and lipid metabolism related indexes, bone turnover markers were measured and 99mTc-MIBI SPECT/CT scan of parathyroid glands were performed for all patients. According to the results of 99mTc-MIBI SPECT/CT imaging, patients were divided into MIBI positive group and MIBI negative group. The baseline clinical data, hematological indexes and bone metabolism related indexes were compared between two groups. The correlation of biochemical indexes with 99mTc-MIBI SPECT/CT findings and the influencing factors of positive 99mTc-MIBI SPECT/CT findings were analyzed. The receiver operating characteristic(ROC) curve was used to analyze the value of serum PTH, corrected Ca, P and their combination in predicting positive results of 99mTc-MIBI SPECT/CT imaging in PHPT. A prediction model for positive 99mTc-MIBI SPECT/CT imaging was generated by Logistic discrimination. ResultsThe levels of serum PTH(P=0.022), corrected Ca (P<0.001)in the MIBI positive group was significantly higher, and serum P level was significantly lower (P=0.020)than those in the MIBI negative group. Spearman correlation analysis showed that serum PTH(P=0.021) and corrected Ca(P<0.001) levels were positively correlated with positivity of MIBI; serum P level(P=0.025) was negatively correlated with positivity of MIBI. Logistic regression analysis showed that that serum corrected Ca was an independent influencing factor for positivity of MIBI(OR: 21.96, 95%CI: 2.829-170.530, P=0.003). The area under the ROC curve(AUC) of combined PTH, corrected Ca and P in predicting MIBI imaging results was 0.748(95%CI: 0.651-0.845). ConclusionThe combination of serum PTH, corrected Ca and P levels has certain value in predicting the results of 99mTc-MIBI SPECT/CT imaging, suggesting that it may be used in screening patients with suspected PHPT.
Key words:  parathyroid hormone  corrected calcium  phosphorus  99mTc-MIBI SPECT/CT  primary hyperparathyroidism

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