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目的研究维持性血液透析患者超声评估甲状旁腺增生的患病率,并结合临床资料分析甲状旁腺增生的影响因素,探讨甲状旁腺激素水平对甲状旁腺增生的预测价值。方法选取2015年7月~2015年12月上海交通大学医学院附属瑞金医院血液净化中心维持性血液透析(maintenance hemodialysis,MHD)患者,收集患者基线时性别、年龄、透析龄、原发疾病、用药情况和血生化指标。使用Philips i E33彩色多普勒超声诊断仪评估甲状旁腺增生,探头频率11MHz。结果 2011年7~12月期间,共有96例MHD患者进入本研究,其中56例(58.3%)原发疾病为慢性肾小球肾炎,60例(62.5%)为男性,年龄(56.2±13.3)岁,透析龄(75.8±55.6)月。96例MHD患者中,54例(57.3%)患者B超可见甲状旁腺增生,其中41例(42.7%)为左侧甲状旁腺增生,44例(45.8%)为右侧甲状旁腺增生,29例(30.2%)为双侧甲状旁腺增生。透析龄<36个月、36~72个月和≥72个月的患者超声诊断甲状旁腺增生的患病率分别为34.6%、54.5%和68.8%,3组间有统计学差异(χ~2=0.018,P=0.018)。比较甲状旁腺增生组(n=54)和无甲状旁腺增生组(n=42)两组间患者临床资料、生化指标和药物治疗情况,发现甲状旁腺增生组透析龄更长(t=-3.507,P=0.001)、血磷(t=-2.591,P=0.011)和全段甲状旁腺激素(intact parathyroid hormone,i PTH)水平更高(Z=-4.328,P<0.001),以及维生素D制剂使用率(χ~2=11.197,P=0.001)更高。受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)显示i PTH水平能有效预测甲状旁腺增生(AUC=0.758,P<0.001,95%CI 0.661~0.855)。当i PTH为456.9pg/ml时,其对甲状旁腺增生预测的敏感性为57.4%,特异性为88.1%。结论甲状旁腺增生是尿毒症患者常见的并发症之一,超声检查是评估尿毒症患者甲状旁腺增生的有效手段。较长的透析龄、高甲状旁腺激素水平、高磷血症和活性维生素D制剂的应用与甲状旁腺增生相关。当i PTH>400pg/ml时,建议常规行甲状旁腺超声评估甲状旁腺增生情况。
Objective To study the prevalence of parathyroid hyperplasia by ultrasound in maintenance hemodialysis patients and to analyze the influencing factors of hyperparathyroidism by clinical data and to explore the predictive value of parathyroid hormone levels in hyperplasia of parathyroid glands. Methods From July 2015 to December 2015, patients with maintenance hemodialysis (MHD) at the Blood Purification Center of Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine were enrolled in this study. Gender, age, dialysis age, primary disease, medication Situation and blood biochemical indicators. Parathyroid hyperplasia was assessed using a Philips i E33 color Doppler ultrasound scanner at a probe frequency of 11 MHz. Results A total of 96 MHD patients were enrolled in this study from July to December in 2011. Among them, 56 (58.3%) had primary glomerulonephritis, 60 (62.5%) were male, and (56.2 ± 13.3) Years old, dialysis age (75.8 ± 55.6) months. Of the 96 MHD patients, 54 cases (57.3%) had hyperparathyroidism in B ultrasound, of which 41 (42.7%) were hyperplasia of the left parathyroid gland, 44 (45.8%) were hyperplasia of the right parathyroid gland, Twenty-nine patients (30.2%) had bilateral hyperparathyroidism. The prevalences of ultrasound diagnosis of parathyroid hyperplasia were 36.6%, 54.5% and 68.8% in patients with dialysis age <36 months, 36-72 months and ≥72 months, respectively, with statistical significance (χ ~ 2 = 0.018, P = 0.018). Comparing the clinical data, biochemical indexes and drug treatment between the patients with parathyroid hyperplasia (n = 54) and non-parathyroid hyperplasia (n = 42), we found that the dialysis age was longer in hyperparathyroidism group (t = -3.507, P = 0.001), serum phosphorus (t = -2.591, P = 0.011) and intact parathyroid hormone (i PTH) were higher (Z = -4.328, P <0.001) Vitamin D preparation usage (χ ~ 2 = 11.197, P = 0.001) was higher. Receiver operating characteristic curve (ROC curve) showed that i PTH level could effectively predict parathyroid hyperplasia (AUC = 0.758, P <0.001, 95% CI 0.661-0.855). When i PTH was 456.9 pg / ml, its sensitivity to parathyroid hyperplasia was 57.4% and its specificity was 88.1%. Conclusion Hyperplasia of parathyroid glands is one of the common complications of uremia patients. Ultrasonography is an effective method to evaluate the hyperplasia of parathyroid glands in patients with uremia. The use of longer dialysis ages, hyperparathyroid hormone levels, hyperphosphatemia and active vitamin D preparations is associated with hyperplasia of the parathyroid glands. When i PTH> 400pg / ml, the proposed routine parathyroid ultrasound assessment of parathyroid hyperplasia.