Ultrasonographic Screening And Preoperative Evaluation Of Secondary Hyperparathyroidism In Patients With Chronic Renal Failure

Objective Recent years,the prevalence of secondary hyperparathyroidism-induced chronic renal failure has continued to rise and remained a high level over the past 10 years.With the constant development of dialytic techniques,lifetimes of patients with chronic nephropathy have presented a gradually increase;however,the quality of patients’ life have been severely influenced by SHPT,which seriously damaged the calcium phosphorus metabolism,and is the close concern of uremia bone disease,soft tissue or vascular calcification,cardiovascular events,and so on.Timely and accurate diagnosis of SHPT is vital for the treatment of patients with chronic nephropathy.Although the detection of serum calcium and i PTH is a reliable diagnostic method of SHPT,other modern imaging methods,such as ultrasound,CT,MR,radioisotope scanning,etc.,can objectively reflect the pathomorphological changes of parathyroid hyperplasia via size,form,structure,blood supply and other more aspects.Thus an accurate inspect method is really important for the success of diagnosis and treatment.In this study,by comparing the application of SHPT on the diagnosis,treatment and therapy,we analyzed and discussed the significance and value of ultrasound in SHPT early scanning and the preoperative assessment of total parathyroidectomy with autotransplantation(TPTX + AT),respectively.Methods 300 maintenance hemodialysis patients were selected.The values of the serum concentration of intact parathyroid hormone(i PTH),calcium(Ca)and phosphate(P)as well as the dialysis age of these patients were recorded respectively.CDUS wasapplied to evaluate the condition of parathyroid hyperplasia.Note the number,size,shape,internal echo and blood flow.Moreover,25 additional patients with TPTX and AT were chose for a surgery therapy of their own accord.Preoperative imaging examinations including ultrasound,radioisotope scanning and CT were supplied and comparatively analyzed to assess the accuracy of parathyroid hyperplasia compared with the surgery pathology.Meanwhile,the change of the biochemical indicators and symptoms of these patients were observed.Results1.In the routine screening group of 300 selected patients.There was a significant difference of i PTH and dialysis age between the two groups of patients with parathyroid hyperplasia and without parathyroid hyperplasia(P<0.05).The i PTH and dialysis age of the parathyroid hyperplasia group were significantly higher than the group without parathyroid hyperplasia(P<0.05).2.In the group,624 hyperplastic parathyroid glands were detected by ultrasonography,of which 262 were less than 15 mm in diameter,about 80% were round,and no cystic lesions were found in the interior.70% of which were lobular or irregular in diameter > 15 mm.In 65 of them,cystic degeneration was found in 65 patients with diameter more than 15 mm,which was more irregular and more likely to develop cystic degeneration(P < 0.05).3.In the surgical group of 25 selected patients.Compared with operation pathology,thedetection rates of hyperplastic parathyroid glands by ultrasound,CT and radionuclidescanning were 93.8%,40% and 35%,respectively.The detection rate of ultrasound wasobviously higher than that of CT and nuclide scan(P<0.05).4.Postoperative follow-up study of the patients with(TPTX + AT)showed the difference of the i PTH and biochemical criterion over different time periods between pre-and post-operation.After surgery,the serum concentration of intact parathyroidhormone(i PTH),calcium(Ca)and phosphate(P)have showed a significant decline(p<0.05),whereas the difference over different postoperative time periods has no statistics significance.The hemodialysis adequacy of postoperative patients was higher than that of preoperation,and triglyceride was significantly lower than that before operation.Meanwhile,clinical symptoms and living quality of patients after surgery have presented a continuous improvement;symptoms such as ostalgia,pruritus,restless legs and so on,have been significantly eased,as well as the sleep and metal state of patients have been improved.Conclusion IPTH and dialysis age are the extremely important influence factors for the screening of maintaining dialysis patients with parathyroid hyperplasia.Compared with other imaging,ultrasound has demonstrated obvious superiority in the diagnostic accuracy of parathyroid hyperplasia,which has indicated that ultrasound can be used as a reliable examination method for the clinical routine screening and preoperative diagnosis of the number and position of parathyroid hyperplasia nuclide,as well as radioisotope scanning and CT applied to assess the existence of the ectopic parathyroid gland as a necessary supplement method.