| ObjectiveThis study aims to analyze the clinical characteristics of patients with primary hyperparathyroidism(PHPT),improve clinical understanding of the disease,reduce missed diagnosis of the disease,and increase the success rate of surgery.MethodsA collection of 305 patients with primary hyperparathyroidism undergoing surgery from January 2015 to December 2020 to the First Affiliated Hospital of Zhengzhou University,and retrospective analysis of their general data,biochemical test data,imaging examination data,and surgical data,Pathological data and follow-up data.ResultsAmong the 305 PHPT patients,there were 103 males and 202 females.T he age of male patients was 48.76±15.40(14-79)years old,and the age of fe male patients was 52.82±12.37 years(17-89)years old.The difference in age of onset between male and female patients was statistically significant.(p=0.02).The serum calcium,blood phosphorus,and serum parathyroid hormone(PT H)levels on the day of admission were higher than the serum calcium,blood phosphorus,and serum PTH levels on the first day after surgery,and the diff erences were statistically significant(p<0.01).The sensitivity of neck ultrasound is 85.90%,the sensitivity of parathyroid MIBI dual-phase scan is 90.60%,an d the sensitivity of neck-enhanced CT is 82.10%,combined with ultrasound an d parathyroid MIBI dual-phase scan The sensitivity is 97.22%.The preoperativ e serum calcium,serum PTH and tumor diameter of parathyroid benign lesions were lower than those of parathyroid malignant tumors.The difference betwee n the two was statistically significant(p<0.05).The preoperative serum calcium and serum PTH The diameter of the parathyroid glands and the diameters of the parathyroid glands are used as the indicators to be tested.The routine path ological report after surgery is used as the gold standard for the diagnosis of parathyroid cancer.According to the Youden index,the best cut-off point,sens itivity and specificity of each indicator to be detected are determined.The resu Its showed that the best cut-off point of preoperative serum calcium,serum PT H and paralesion gland diameter:3.245mmol/L,382.3pg/mL,2.9cm,The sensit ivity of the combination of preoperative serum calcium and tumor diameter or the combination of the three is the highest,67.7%.There was a weak positive correlation between preoperative serum calcium,serum PTH and tumor diamet er(p<0.01,R=0.37,0.49).There was no significant difference between single gland disease and multiple gland disease in preoperative serum calcium,serum PTH,blood phosphorus,age,and tumor diameter size(p>0.05).Ultrasound is sensitive to diagnosis of single gland disease and multiple gland disease The sensitivity of MIBI dual-phase scan of parathyroid glands in the diagnosis of s ingle gland disease is significantly higher than that of multiple gland disease.There is a difference in MGD(Multiple gland)score between single gland dis ease and multiple gland disease.Conclusion1.PHPT patients have a wide range of first consultation departments,a high rate of misdiagnosis,and a variety of first symptoms,most of which have multiple system damage manifestations,and the number of people with symptoms of the skeletal system is the largest.2.Both ultrasound and parathyroid MIBI dual-phase scanning have high sensitivity,and the combination of the two can significantly improve the sensitivity of diagnosis.3.There is no significant difference in preoperative serum calcium,serum PTH,and tumor diameter between single-glandular parathyroid lesions and multi-glandular lesions.There are differences in the MGD scores of the two,but the scores are all distributed in the low segment.The analysis difference may mainly come from the difference in imaging examination results,so the clinical practicality is not high.4.The effect of PHPT surgery is clear,and all biochemical indicators have improved after surgery.5.Parathyroid carcinoma and parathyroid benign lesions are different in preoperative serum calcium,serum PTH,and tumor diameter.By drawing ROC curve,we found that the combination of preoperative serum calcium and parathyroid gland diameter or the combination of the three The diagnosis of parathyroid cancer is helpful.Before the operation,the serum calcium is higher than 3.245mmol/L,the tumor diameter is larger than 2.9cm,and the PHPT with serum PTH higher than 382.3pg/mL should be alert to the possibility of parathyroid cancer. |
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