摘要
总结１９５８～１９９３年间１３４例原发性甲状旁腺功能亢进症（简称甲旁亢）的诊断经验。临床表现有骨吸收（５６．０％）、骨病变合并尿路结石（３５．０％）、单纯尿路结石（６．０％）和高钙血症（３．０％）４种类型。骨病变有骨吸收、并骨软化和骨质疏松；尿路结石中７２．７％为多发结石或／和肾钙化。血游离钙测定与，总钙值的诊断符合率分别为９５．３％和７３．４％，血免疫活性甲状旁腺素（ｉＰＴＨ）值比正常组明显增高。定位诊断首选颈部Ｂ超，其次为核素扫描；高度考虑纵隔异位病变时可行ＣＴ扫描；首次手术失败，再次手术前可应用选择性颈内静脉插管取血测ｉＰＴＨ浓度的定位方法。
This article reports the diagnostic experiences of 134 cases of pfimary hyperparathyroidism(PHPT))confirmed by operation and pathologic examination. The clinical presentations were divided into 4 types :(1) 75 cases(56.0%)with bone resorption ;(2)47 cases(35.0%)with bone lesions plus urinary calculus;(3) 8 cases(6.0%)with urinary calculus only and;(4) 4 cases(3.0%)with hypercalcemia only. Bone lesions included bone resorption,osteomalacia and osteoporosis. Stones at multiple sites in the urinary tract or nephrocalcinosis were found in 41 cases. The measurement of ionized calcium was much more sensitive and accurate than the total calcium assay with the positive rate of 95.3% and 73.4% respectively. The concentration of plasma iPTH was high in the whole group(n=84),the mean value was 21.4±17.9 times higher than that of the normal control group.For the localization of the affected parathyroid gland , instiat examination was by neck ultrasonography which gone a positive predictive value of 81.5%(43/53),99mTc-MIBI scan showed positive rate 94.1%(16/17). The CT scan of the chest was used when ectopic location in mediastinum was highly suspected. If the first operative exploration failed to find the affected parathyroid gland, we performed the determinations of iPTH with samples taken from internal jugular vein through selective venous catheterization; the coincidence rate was found to be 85.2%(23/27).
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
1994年第1期13-19,共7页
Acta Academiae Medicinae Sinicae
关键词
血游离钙
甲状旁腺激素
甲亢
诊断
primary hyperparathyroidism,serum ionized calcium,parathyroid hormone,multiple endocrine adenoma
