Clinical Analysis Of Primary Hyperparathyroidism With Multi-glandular Diseases

Objective: Primary hyperparathyroidism is a series of clinical syndromes,such as hypercalcemia,which is caused by hyperparathyroidism and its influence on bone and kidney.Because the number of parathyroid gland is not fixed,there may be multiple pathological glands,which is easy to be missed in clinic,leading to treatment failure.The purpose of this study is to analyze the clinical characteristics of primary hyperparathyroidism with multiple glands,explore and verify the possible predictive model of multiple glands disease,and reduce the rate of missed diagnosis.Methods: 218 cases of primary hyperparathyroidism were collected from the First Affiliated Hospital of Zhejiang University from January 2013 to March 2019.The clinical data were analyzed retrospectively.At the same time,the differences in biochemistry and imaging between multiple gland diseases and single gland diseases were analyzed.Results: In this study,there were 65 female patients,153 male patients,with an average age of 52.75 years,14 patients with multiple gland diseases and 204 patients with single gland diseases.Compared with single gland diseases,the rate of missed diagnosis of multiple gland diseases was significantly increased(P < 0.01,< 0.01,<0.01).It was found that there were significant differences(P = 0.026,0.015,0.01)in the maximum diameter of parathyroid gland,preoperative parathyroid hormone and preoperative blood calcium,and there were also significant differences(P < 0.01)in the calculation of win index(the product of blood calcium and serum parathyroid hormone).In logistic multivariate regression analysis,the size of parathyroid gland in patients with multiple gland diseases was the only index that was significantly different from that in patients with single gland diseases(OR = 4.10,95% CI: 1.39-11.99,P = 0.01).ROC curve analysis of related factors found that the maximum transverse diameter has a good predictive ability for multi-glandular disease(AUC = 0.75,95% CI: 0.65-0.87,P =0.01),and blood calcium can also predict multi-glandular disease.Disease(AUC = 0.69,95% CI: 0.58-0.80,P = 0.019),but the correlation between preoperative PTH,Win index and the number of glands was not strong(P values: 0.30,0.24).The cutoff value of the largest transverse diameter is 1.45 cm,and the sensitivity for diagnosing multi-glandular disease is 79.4%,and the specificity is 57.1%.The cutoff value of blood calcium is 2.62 mmol / L,and the sensitivity for diagnosing multi-glandular disease is71.6%,the specificity is 64.3%.There was no significant difference in MGD like index between multiple gland diseases and single gland diseases(P = 0.53).Conclusion: Patients with primary hyperparathyroidism undergo preoperative imaging localization.If it is a single diseased gland,when the blood calcium value is less than 2.62 mmol / L or the maximum gland diameter is less than 1.45 cm,multi-gland disease should be considered existence;if there are multiple or no diseased glands,vigilance for multi-glandular disease is also required.The use of the above model can assist in the evaluation of primary hyperparathyroidism multi-glandular disease,reduce preoperative missed diagnosis,and facilitate further development of subsequent diagnosis and treatment.