Study On The Correlation Between Ultrasonography And Clinical Examination Indicators In Intractable Secondary Hyperparathyroidism Patients With Renal Insufficiency

Objective The characteristics of high frequency ultrasound and ultrasound contrast in patients with refractory secondary hyperparathyroidism were analyzed and the relationship between the ultrasonic measurement values of refractory secondary hyperparathyroidism and the clinical test indexes was studied.To understand the efficacy and significance of ultrasonography in the treatment of refractory secondary hyperparathyroidism.Method 30 cases were diagnosed as refractory secondary hyperparathyroidism who transparathyroid total resection with autologous transplantation and confirmed by postoperative pathology.High frequency ultrasound examination and ultrasound contrast examination were executed before operation.The ultrasonographic features of each parathyroid gland,such as morphology,boundary,internal echo and blood flow signal,were recorded.The length,width and thickness of parathyroid glands were measured under two-dimensional ultrasound.The length,width and thickness of the parathyroid glands and non enhanced region were measured under contrast-enhanced ultrasound.The sum of the volume of the parathyroid parathyroid in each patient was calculated.The sum of two-dimensional ultrasound parathyroid volume and enhancement of regional volume of parathyroid glands by ultrasound contrast in each patient was calculated.The clinical indicators of the patients within 24 hours before operation were recorded: serum parathyroid hormone,serum calcium,serum phosphorus and serum alkaline phosphatase.Calculation correction of serum calcium,correction of serum calcium and phosphorus product.The correlation analysis of the sum of the volume of parathyroid parathyroid,the volume of parathyroid parathyroid region and the parathyroid hormone,serum calcium,serum phosphorus,serum alkaline phosphatase,the correction of serum calcium,and the correction of the product of serum calcium and phosphorus.Univariate t test was performed for the difference between the volume of hyperparathyroid calculated by two dimensional ultrasound and the volume of enhanced ultrasound enhanced volume.Result High frequency ultrasound in refractory secondary hyperparathyroidism is characterized by increased volume and clear boundary.The average sum of parathyroid volume measured by two-dimensional ultrasound was(3.35 + 2.07)cm3,and the volume of enhanced regional was(3.53 + 2.13)cm3.The morphology of the parathyroid gland was elliptical(66.39%)and shallow lobulated(26.05%).The echo is dominated by low uniformity(94.12%).The uneven echo is mainly caused by uneven distribution of solid echo,which is rare due to calcification and liquefaction.The blood flow signals of parathyroid glands are abundant(98.08%,II-III grade).Poor blood flow is rare(0-I grade1.68%).Most of the hyperparathyroidography showed homogeneous,slightly enhanced or equal enhancement(95.80%),rare(8.40%)filling defect.The initial enhancement time was much earlier than that of the surrounding normal thyroid tissue.Parathyroid glands and thyroid tissues were almost simultaneously in peak and synchronous clearance.The correlation between parathyroid hormone volume and parathyroid hormone was positively correlated(r=0.48,P=0.01).There was a positive correlation between the volume of parathyroid gland and the parathyroid hormone(r=0.50,P=0.01).The correlation analysis between two dimensional ultrasound and ultrasound contrast enhanced hyperparathyroid volume was not statistically significant to serum calcium,serum phosphorus,alkaline phosphatase,corrected serum calcium and calcium and phosphorus products(with all P > 0.05).The difference between the sum of two-dimensional ultrasound parathyroid volume and the volume of parathyroid gland in contrast enhanced ultrasound was not statistically significant(P > 0.05).Conclusion The ultrasonic manifestations of refractory secondary hyperparathyroidism are mainly hypoechoic,rare,no echo and strong echo.Two dimensional ultrasound showed that the hypoechoic echogenicity could be enhanced.The sum of the parathyroid volume calculated by two-dimensional ultrasound and the sum of the parathyroid enhanced regional volume by ultrasound contrast can reflect the secretion state of parathyroid glands.The volume of contrast enhanced ultrasound reflects the accuracy of parathyroid secretion.The sum of parathyroid volume and the volume of contrast-enhanced ultrasound can not reflect the calcium and phosphorus metabolism in refractory SHPT patients.