| Objective:Secondary hyperparathyroidism(SHPT)is one of the most common and serious complications of chronic renal failure.In recent years,with the improvement and development of hemodialysis technology,the survival time of patients with end-stage renal failure has been prolonged,and the incidence of SHPT was increasing.SHPT often causes abnormal mineral and bone metabolism,which seriously affects the quality of life of patients with end-stage renal disease.This study combined the preoperative laboratory examination and postoperative pathology of 178 patients with the preoperative ultrasound findings to explore the ultrasound findings and clinical application value of SHPT.Methods:178 patients with refractory secondary hyperparathyroidism who underwent concurrent surgery in our hospital from January 2015 to December 2017 were selected.All patients were resistant to vitamin D shock therapy.The patient’s dialysis age,parathyroid hormone,serum alkaline phosphatase,serum albumin,serum calcium,serum phosphorus were recorded one by one,and the corrected serum calcium and corrected serum calcium-phosphorus product were calculated.Ultrasound was performed before surgery in all cases.The size,echo,number,location,calcification and blood flow of the abnormal parathyroid glands were recorded.Pathological examination was performed after the operation.Retrospective analysis of the accuracy and characteristics of ultrasound examination,as well as the correlation between ultrasound performance and laboratory indicators.Results:1.A total of 681 parathyroid glands were surgically removed in 178 patients.A total of 599 parathyroid glands were detected by ultrasound and 576 were consistent with pathology.The coincidence rate was 96.2%(576/599),23 were misdiagnosed,including 1 thyroid tissue and 22 lymph nodes.The sensitivity is 84.6%(576/681).2.There was no significant difference in sensitivity between the left and right parathyroid hyperplasia(X2.88,p>0.05).The sensitivity of the left lower parathyroid hyperplasia was higher than that of the left upper one.The difference was statistically significant(X2=17.62,p<0.01).The sensitivity of the right lower parathyroid hyperplasia was higher than that of the right upper one.The difference was statistically significant(X2=20.67,p<0.01).The sensitivity of the lower parathyroid hyperplasia was higher than the upper one.It has statistical significance(X2=37.94,p<0.01).3.The single largest volume hyperplasia of the parathyroid glands was located in the left upper side in 37 cases,the left lower side in 42 cases,the right upper side in 37 cases,and the right lower side in 62 cases.Among them,there were 74 cases(74/178,41.6%)in the upper position and 104 cases(104/178,58.4%)in the lower position.4.There was a positive correlation between parathyroid volume and PTH,serum calcium,adjusted serum calcium,corrected serum calcium and phosphorus product(r=0.16,0.51,0.50,0.225,p<0.05).And there was no correlation with ALP and serum phosphorus(p>0.05).5.The calcified group had significantly higher PTH,ALP and serum calcium levels than those in the non-calcified group(p<0.05).6.The AUC(area under the curve)of the parathyroid volume combined with the average volume of the parathyroid gland was 0.65,the p value was 0.03,the sensitivity was 0.55 and the specificity was 0.82.Conclusion:1.This article found that a history of uremia combined with ultrasound measurement of parathyroid gland with a single diameter>5mm,clear boundary,internal hypoechoic and increased blood flow signal to diagnose parathyroid hyperplasia was better.Compared with surgical pathology,ultrasound detection was consistent with pathology of 96.2%and sensitivity was 84.6%.Conventional ultrasound combined with color doppler flow signal can better detect SHPT and provide treatment decision for clinicl.2.The volume of parathyroid gland was positive correlation with serum calcium and corrected serum calcium(r=0.51,0.500,p<0.05),and was slightly positive correlation with PTH and corrected serum calcium-phosphorus product(r=0.16,0.22,p<0.05),no correlation with ALP and serum phosphorus.Therefore,serum calcium and corrected serum calcium can also be used as reference indicators for the diagnosis of secondary parathyroid hyperplasia.3.In this study,the presence of calcification in the parathyroid glands,the volume of parathyroid gland,PTH,ALP,and corrected serum calcium were significantly higher than those in the uncalcified group.It suggested that the condition of calcification occurred in the parathyroid glands of secondary hyperparathyroidism is heavier and should be treated first and promptly.4.This paper found that the AUC(area under the curve)of the parathyroid gland volume combined with the average volume of the parathyroid gland to diagnosis of parathyroid hyperplasia was 0.65,the p value was 0.03,the sensitivity was 0.55,and the specificity was 0.82.It indicates that the volume of the parathyroid gland is closely related to the state of hyperplasia.The volume of parathyroid gland may reflect the severity of SHPT and can provide a good reference for clinical treatment ’and preoperative positioning.5.As a common examination method for parathyroid glands,ultrasound has the advantages of high accuracy and specificity.It is an important means to monitor the parathyroid glands and has important clinical application value. |
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