| BackgroundPrimary hyperparathyroidism,a group of clinical syndrom caused by excessive secretion of parathyroid hormone in the primary lesion of parathyroid tissue,including hypercalcemia Symptoms,renal calcium reabsorption and increased urinary phosphorus excretion,kidney stones,renal calcinosis and increased bone resorption which major in cortical bone.The clinical manifestations of the disease are heterogeneous,and the duration of the disease varies.It is easy to cause missed diagnosis and misdiagnosis in clinic,which brings trouble to clinicians.Asymptomatic PHPT refers to the lack of the above typical performance,only manifested as a slight increase in blood calcium and PTH levels.After pathological examination,the common pathological type of PHPT is parathyroid adenoma(PA),accounting for 75%-85% of all patients.At present,there are only a few single-center small-sample studies in the domestic research on PHPT.This study retrospectively analyzed clinical data of 265 patients with primary hyperparathyroidism the biochemical indicators and surgical pathology in the first affiliated hospital of Zhengzhou University from January 2012 to December 2017,to improve our understanding of the disease.ObjectiveTo summarize the clinical features of patients with PHPT in our hospital,to compare the clinical features between symptomatic PHPT and asymptomatic PHPT and the differences in different pathological types of PHPT,and to evaluate the preoperative diagnostic value of serum calcium,PTH and ALP for parathyroid carcinoma.MethodsPatients who had a clear pathological diagnosis of primary hyperparathyroidism from January 2012 to December 2017 in the First Affiliated Hospital of Zhengzhou University were included in the study.The general data,clinical manifestation biochemical examinations,imaging examinations and pathological features of all subjects were retrospectively analyzed.Results1.Of the 265 patients with PHPT,70(26.4%)were male and 195(73.6%)were female,with the ratio of male to female was 1:2.78,the average age is 51.31±13.45 years old(15~85),and 199(75.1%)patients was 40~70 years old.The pathological type of 207(78.1%)patients was parathyroid adenoma,22(8.3%)was parathyroid hyperplasia,32(12.1%)was parathyroid carcinoma,and 4 patients were uncertain.2.The positive rate of parathyroid ultrasonography was 62.9%,the positive rate of 99mTc-MIBI SPECT/CT was 91.4%,and the positive rate of 99mTc-MIBI SPECT/CT was significantly higher than that of color Doppler ultrasound.The positive rate of the joint examination was 94.9%.3.The serum calcium,corrected serum calcium,ALP,PTH,uric acid and FBG in the sPHPT group were higher than those in the aPHPT group(P<0.05).The diastolic blood pressure,serum phosphorus,albumin and HDL-C in the sPHPT group were lower than those in the aPHPT group(P<0.05).4.The blood calcium,corrected serum calcium,ALP,PTH,creatinine and TG in the PC group were higher than those in the PA group(P<0.05).There were no significant differences in the symptoms of bone,kidney and digestive system between the two groups(P>0.05).5.Logistic regression analysis showed that serum calcium,ALP,and creatinine were the risk factors for preoperative assessment of parathyroid carcinoma(P<0.05).6.Serum calcium was positively correlated with ALP,PTH,creatinine,uric acid,FBG and TG(P<0.05),but negatively correlated with serum phosphorus and HDL-C(P<0.05).PTH was positively correlated with serum calcium,ALP,creatinine,uric acid and TG(P<0.05),and negatively correlated with serum phosphorus and HDL-C(P<0.05).ALP was positively correlated with serum calcium and PTH(P<0.05),and negatively correlated with serum phosphorus and HDL-C(P<0.05).7.ROC curve analysis showed that the optimal cut-off value of blood calcium screening for parathyroid carcinoma was 3.29mmol/L,and the optimal cut-off value for PTH screening for parathyroid carcinoma was 382.30pg/ml.ALP screening for parathyroid gland The best cut-off point for cancer is 258.50 U/L.The sensitivity of combined detection of blood calcium,PTH and ALP was 82.8%,and the specificity was 69.4%.AUC was higher than single detection and double detection.Conclusions1.The patients with PHPT are more common in women.Most patients was 40~70 years old.The proportion of aPHPT is 41.9% and the proportion of parathyroid carcinoma is 12.1%.2.Combined detection of parathyroid ultrasound and 99mTc-MIBI SPECT/CT in PHPT patients can improve the detection rate of parathyroid disease.3.Blood calcium,PTH,and ALP have certain preoperative diagnostic value for parathyroid carcinoma,and three combined tests can improve the diagnostic value. |
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