摘要
的为提高骨显像对骨性原发性甲状旁腺功能亢进症（PHPT）的诊断效率，对117例PHPT患者骨显像特点进行分析。方法117例PHPT患者，男50例，女67例，其中116例为甲状旁腺腺瘤，1例为甲状旁腺腺癌，平均年龄61．1（12～86）岁。所有患者均行^99Tc^m-亚甲基二膦酸盐（MDP）显像，骨显像图分为4种类型：Ⅰ型骨显像阴性；Ⅱ型骨显像局部骨异常，即局灶型，又再分为2个亚型：ⅡA型颅骨和下颌骨放射性浓聚，ⅡB型表现为除有ⅡA型特点外，还存在其他局部骨代谢异常；Ⅲ型全身骨放射性摄取增加；Ⅳ型表现为全身＋局部骨代谢异常。用χ^2检验和独立样本t检验进行统计学处理。结果117例骨显像表现为Ⅰ型者47例，占40．17％；Ⅱ型35例，占29．91％，其中ⅡA21例，ⅡB14例；Ⅲ型30例，占25．64％；Ⅳ型5例，占4．27％。70例Ⅱ、Ⅲ、Ⅳ型异常骨显像PHPT患者有骨折史、结石史、骨折＋结石史、骨质疏松史和骨痛史，分别占55．71％（39例）、11．43％（8例）、10．00％（7例）、72．86％（51例）和37．14％（26例）；而47例骨显像Ⅰ型者上述病史分别为2．13％（1例），0，0，21．28％（10例）和21．28％（10例）。两者各种病史发生率相比差异有统计学意义（χ^2=11．152，P=0．01）。Ⅱ、Ⅲ、Ⅳ型（骨显像异常）与Ⅰ型患者的肿瘤体积、甲状旁腺激素（PTH）、血钙、血磷分别为（14．52±13．72）cm^3和（0．78±1．33）cm^3、（731．67±618．40）ng／L和（112．04±62．98）ng／L、（3．05±0．29）mmol／L和（2．56±0．42）mmol／L、（0．71±0．14）mmol／L和（1．03±0．36）mmol／L，两者相比t=-5．724，-5．741，-7．274和-6．451，P均〈0．01，差异也有统计学意义。结论（1）约40％PHPT患者骨显像正常；（2）PHPT患者4种骨显像结果反映了骨损害的情况；（3）PHPT的骨显像特点有助于该病的鉴别诊断。
Objective To analyze the characteristics of bone seintigraphy in 117 cases with primary hyperparathyroidism （PHPT）. Methods Of these 117 cases （50 males and 67 females） , there were 116 parathyroid adenomas and 1 parathyroid cancer. Mean age was 61.1 （12- 86 ） years old. All had ^99Tc^m- methylene diphosphonate （MDP） bone scintigraphy. The bone images could be classified into 4 categories. Category Ⅰ ： normal; category Ⅱ ： localized abnormal, which could be subcategorized as H A with skull and mandible involvement, and Ⅱ B with Ⅱ A characteristics plus metabolic derangement ; category Ⅲ ： systemic, whole-body increased tracer uptake; category Ⅳ： systemic plus localized metabolic derangement. Data were analyzed statistically with χ^2 and t-test （ isolated samples）. Results According to the scintigraphic findings, there were 47 cases （40.17%） of category Ⅰ , 35 cases （29.91%） category Ⅱ （21/35 cases Ⅱ A and 14/35 cases Ⅱ B） , 30 cases （25.64%） category Ⅲ, and 5 cases （4.27%） category Ⅳ. Combining categories Ⅱ , Ⅲ and Ⅳ together, there were 70 abnormal cases. These patients had history of abnormal bone images such as bone fracture （39 cases, 55.71% ）, calculus （8 cases, 11.43% ）, bone fracture plus calculus （7 cases, 10.00% ）, osteoporosis （51 cases, 72. 86% ） or ostalgia （26 cases, 37.14% ） ; however, in the 47 cases of category Ⅰ, only 1 （2.13%）, 0, 0, 10 （21.28%） and 10 cases （21.28%）, respectively, were found. Therefore, these case history characteristics were statistically significant （χ^2 = 11. 152, P = 0.01 ）. The tumor size, parathyroid hormone （PTH）, blood calcium, blood phosphorus in the patients of abnormal PHPT categoriesⅡ to Ⅳ were （ 14.52 ± 13.72） cm^3, （731.67 ±618.40） ng/L, （3.05 ± 0. 29 ） mmol/L and （0.71 ± 0.14） mmol/L, respectively, with statistically significant difference compared to category Ⅰ ： （0.78 ± 1.33） cm^3, （ 112.04 ± 62.98） ng/L, （2. 56 ± 0.42） mmol/L and （ 1.03 ± 0.36） mmol/L （t= -5.724, -5.741, -7.274 and -6.451; all P〈0.01）. Conclusions （1）Bone scintigrapby was normal in 40% of PHPT patients. （2）The bone images of PHPT could be classified into 4 categories and each could reflect the duration and severity of the disease status on bone. （3）The bone imaging characteristic could be useful for differential diagnostic purposes.
出处
《中华核医学杂志》
CAS
CSCD
北大核心
2010年第1期38-41,共4页
Chinese Journal of Nuclear Medicine
