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| 尿毒症性甲状旁腺功能亢进经皮微波消融治疗后血清全段甲状旁腺激素的疗效评价作用 |
| 李宏建1，2,章建全3,刁宗平3,夏斐1,李其元1,倪雪君2* |
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| (江苏省淮安市肿瘤医院超声科, 淮安 223200;南通大学附属医院医学超声科, 南通 226001;海军军医大学(第二军医大学)第二附属医院超声诊疗科, 上海 200003;1. 江苏省淮安市肿瘤医院超声科, 淮安 223200) |
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| 摘要: |
| 目的 探讨超声引导下经皮微波消融治疗尿毒症性继发性甲状旁腺功能亢进（SHPT）术后全段甲状旁腺激素（iPTH）作为评判其疗效指标的临床应用价值。方法 回顾性分析2010年1月至2018年12月在海军军医大学（第二军医大学）第二附属医院和淮安市肿瘤医院接受超声引导下微波消融治疗的尿毒症性SHPT患者51例。依据消融策略的不同，将患者分为全消融组（30例）和非完全消融组（21例）。51例患者术前均进行对比增强超声造影（CEUS）和核素定位检查。非完全消融组术前对每个增生腺体完成细针穿刺提取物iPTH测定，全消融组术后均进行CEUS和核素检查，确认增生腺体是否完全消融。所有患者均完成术后9个月随访，分析比较两组术后血清iPTH水平的变化。结果 51例尿毒症性SHPT患者增生腺体共196枚均顺利完成消融治疗。两组术后1 h及1、3、6、9个月时的血清iPTH水平较术前均下降（P均＜0.05）；术后6个月和9个月时，非完全消融组患者的血清iPTH水平均高于全消融组（P均＜0.001）。全消融组4例患者术后6个月时血清iPTH水平发生反弹，非完全消融组4个月时8例患者发生反弹，全消融组出现血清iPTH水平反弹的时间晚于非完全消融组，且反弹幅度低于非完全消融组。全消融组患者术后血清iPTH水平出现反弹的患者比例低于非完全消融组［26.7%（8/30）vs 71.4%（15/21），P＜0.05］。结论 仅以iPTH单纯作为经皮微波消融治疗尿毒症性SHPT术后疗效的主要指标存在缺陷，临床上应建立新的评价体系来综合评估该治疗方法的有效性。 |
| 关键词: 全段甲状旁腺激素 尿毒症 继发性甲状旁腺功能亢进 超声引导 微波消融术 |
| DOI：10.16781/j.CN31-2187/R.20200318 |
| 投稿时间：2020-03-10修订日期：2020-12-18 |
| 基金项目: |
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| Evaluation of therapeutic effect of serum intact parathyroid after percutaneous microwave ablation for uremic hyperparathyroidism |
| LI Hong-jian1，2,ZHANG Jian-quan3,DIAO Zong-ping3,XIA Fei1,LI Qi-yuan1,NI Xue-jun2* |
| (Department of Ultrasound, Huai'an Tumor Hospital, Huai'an 223200, Jiangsu, China;Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu, China;Department of Ultrasound, The Second Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200003, China;1. Department of Ultrasound, Huai'an Tumor Hospital, Huai'an 223200, Jiangsu, China) |
| Abstract: |
| Objective To investigate the clinical value of intact parathyroid (iPTH) in evaluating the treatment outcome of uremic secondary hyperparathyroidism (SHPT) after ultrasound-guided percutaneous microwave ablation.Methods A retrospective analysis was conducted on 51 cases of uremic SHPT patients who received ultrasound-guided microwave ablation in The Second Affiliated Hospital of Naval Medical University (Second Military Medical University) and Huai'an Tumor Hospital from Jan.2010 to Dec.2018.According to different ablation strategies,patients were divided into complete ablation group (30 cases) and incomplete ablation group (21 cases).Contrast-enhanced ultrasound (CEUS) and isotope localization were performed in 51 patients before ablation.In the incomplete ablation group,the iPTH determination of fine needle aspiration extract was completed for each hyperplast glands before operation.In the complete ablation group,CEUS and isotope examination were performed after operation to confirm whether the hyperplast glands were completely ablated.All patients were followed up for 9 months after surgery to analyze and compare the changes of serum iPTH level in the 2 groups.Results A total of 196 hyperplastic glands in 51 uremic SHPT patients were successfully ablated.The serum iPTH levels at 1 h and 1,3,6,9 months after operation in both groups were significantly lower than those before operation (all P<0.05);at 6 and 9 months after operation,the serum iPTH levels of patients in the incomplete ablation group were significantly higher than those in the complete ablation group (both P<0.001).The serum iPTH levels rebounded in 4 patients in the complete ablation group 6 months after operation,and rebounded in 8 patients in the incomplete ablation group 4 months after operation;the rebound time in the complete ablation group was later than that in the incomplete ablation group,and the rebound amplitude was lower than that in the incomplete ablation group.The percentage of patients whose serum iPTH level rebounded after operation in the complete ablation group was lower than that in the incomplete ablation group (26.7%[8/30]vs 71.4%[15/21],P<0.05).Conclusion There are defects in using iPTH alone as the main indicator of the postoperative efficacy of microwave ablation for uremic SHPT,so a new clinical evaluation system should be established to comprehensively evaluate the effectiveness of this treatment. |
| Key words: intact parathyroid hormone uremia secondary hyperparathyroidism ultrasound-guided microwave ablation |
