Correlation Of Ultrasound Composite Score With Parathyroid Function In Patients With Chronic Kidney Disease-mineral And Bone Disorders

PartⅠ Reliability of Ultrasound Parathyroid Identification Strategies in Patients with Chronic Kidney Disease ObjectiveHow to identify the parathyroid gland with high precision is a difficult point in the current research.This paper seeks to summarize the ultrasonic features of parathyroid and formulate parathyroid recognition strategy to improve the recognition rate of parathyroid.MethodsThe starting and ending time is from January 2021 to June 2021.The subjects were patients with chronic kidney disease.Forty-three subjects were included and 112 samples were selected.Ultrasound-guided fine needle aspiration cytology,eluent Tg and iPTH were used as the diagnostic gold standard to evaluate the diagnostic efficacy of "parathyroid identification strategy".ResultsThe iPTH level of parathyroid puncture eluent was 2148.744±796.178pg/ m L,and that of non-parathyroid puncture eluent was 23.676±13.133pg/ml,t=22.954,P<0.01.The accuracy,sensitivity and specificity of the "parathyroid identification strategy" method were 92.857%,93.421%,91.667%,0.925 area under curve。The positive predictive value and negative predictive value of the "parathyroid identification strategy" was 95.946%and 86.842%.ConclusionThe result show that parathyroid judgment strategy can accurately identify parathyroid gland,and this method can provide parathyroid ultrasound information dynamically for patients with chronic kidney.PartⅡ The Diagnostic Value of Ultrasonic Comprehensive Score and 99 m TC-MIBI Duplex Imaging in Refractory Secondary HyperparathyroidismObjectiveThis paper compares the diagnostic efficacy of different evaluation schemes in the following three ways.First,Patients with secondary hyperparathyroidism whose drugs were difficult to control were evaluated by comprehensive score of ultrasound;second,^99mTc-MIBI radioisotope dual-phase imaging;third,combined evaluation of the two methods.MethodsSubjects with iPTH≥300pg/ml and regular dialysis with secondary hyperparathyroidism in Fengfeng General Hospital of North China Medical Health Group were retrospectively analyzed.With iPTH=800pg/ml as cut-off score,group A and group B.Fifty-four subjects（iPTH≥300pg/ml and iPTH < 800pg/ml）were enrolled in group A.Fifty-eight subjects（iPTH≥800pg/ml）were included in group B.Laboratory test indicators of subjects at enrollment were recorded.iPTH was used as the main observation value in laboratory tests.The patients with chronic kidney disease in this study recommended a strictly restricted phosphorus diet.The diagnostic efficacy of combined ultrasound score,^99mTc-MIBI dual-phase imaging and "combined diagnosis" were compared between the two groups.ResultsThe following results are obtained by comparing the connection and difference between group A data and group B data.Group A: 123 parathyroid glands were detected by ultrasound,and 0 parathyroid glands were detected by^99mTc-MIBI dual-phase imaging.In group B,168 parathyroid glands were detected by ultrasound and 97 by^99mTc-MIBI dual-phase imaging,χ2 =59.875,P< 0.001.The detection rate of parathyroid gland by ultrasonography was higher than that by^99mTc-MIBI dual-phase imaging.The area under the curve of ultrasonic comprehensive score and MIBI imaging were 0.887 and 0.784,respectively.The sensitivity of ultrasonic comprehensive score and MIBI imaging were91.38%and58.62%,respectively.The specificity of ultrasonic comprehensive score and MIBI imaging were 88.89%and98.15%,respectively.The AUC of the combined diagnosis ROC was the largest,with a value of 0.937.The sensitivity of the combined diagnosis ROC was higher than that of the other two methods,with a value of 93.10%.The comparison of the AUC detected by the three methods showed differences in each of them,P<0.05.The Jordan index of ROC curve analysis of ultrasonic comprehensive score was0.803,and the cut-off value was 10.The logistic regression model showed that the odds ratio（OR value）of 99 m TC-MIBI dual-phase imaging was 38.565,P<0.05;The odds ratio（OR value）of ultrasonic comprehensive score was 1.1562,P<0.05.ConclusionConsidering all of this evidence,it seems that the comprehensive ultrasonic score has high diagnostic efficiency.When the cutoff value is 10,ultrasound has a good value in the diagnosis of secondary hyperparathyroidism which is difficult to be controlled by drugs.PartⅢ Study on The Correlation between Ultrasonic Comprehensive Score and Parathyroid Function in Patients with Chronic Kidney DiseaseObjectiveThe purpose of this study was to evaluate the evaluation ability of ultrasonic comprehensive evaluation in the real world.MethodsAfter rigorous screening and selection,a total of 107 subjects completed all the tests in this study.All subjects underwent cervical parathyroid scanning using ultrasound equipment.Comprehensive ultrasound score was performed on the patients.The correlation between "ultrasound comprehensive score" and iPTH level was compared.The ROC curve was drawn with iPTH level =300pg/m L as the cut-off value to compare the diagnostic efficacy of ultrasound comprehensive score,parathyroid volume score,internal echo composition score and blood flow score.ResultsThere was a correlation between ultrasonic comprehensive score and iPTH grouping.Spearman rank correlation coefficient was 0.831,P<0.01,and the statistical results showed a positive correlation trend.The comprehensive ultrasonic score was based on the drawn subject working curve AUC = 0.924,sensitivity 92.77%,specificity 87.50%.The AUC of volume score was 0.845,Spearman rank correlation coefficient 0.655,P<0.01,sensitivity69.88%,specificity 95.83%.Internal echo composition scoring method: AUC = 0.842,Spearman rank correlation coefficient 0.572,P<0.01,sensitivity 91.50%,specificity62.50%.The blood flow scoring method,AUC of the drawn subject working curve= 0.798,Spearman rank correlation coefficient 0.702,P<0.01,sensitivity 84.34%,specificity66.67%.ConclusionCollectively,these studies outline a critical role for the evaluation of plasma iPTH in patients with secondary hyperparathyroidism.Combined Ultrasound Score has high sensitivity and specificity,which is a useful supplement to the evaluation of plasma iPTH in patients with secondary hyperparathyroidism.