疑诊原发性甲状旁腺功能亢进症的患者术前^99mTc-MIBI SPECT/CT 显像结果的影响因素分析

Factors associated with preoperative ^99mTc-MIBI SPECT/CT in patients with suspected primary hyperparathyroidism

摘要

目的  探讨疑诊原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT）的患者术前^99mTc -甲氧基异丁基异腈(methoxyisobutylisonitrile，MIBI)单光子发射计算机断层扫描/计算机断层扫描（single-photon emission computed tomography/computed tomography,SPECT/CT)(以下简称MIBI SPECT/CT ）显像结果的影响因素。方法  将2019年1月至2023年8月于首都医科大学附属北京朝阳医院疑诊PHPT并在术前完善甲状旁腺MIBI SPECT/CT显像的257例患者作为研究对象。比较MIBI SPECT/CT显像阳性组和阴性组的实验室检查、病理特征及影像特征。采用多因素Logistic回归分析MIBI SPECT/CT显像结果的影响因素。结果  单因素分析显示，与阴性组相比，血清总钙、血清甲状旁腺激素(parathyroid hormone,PTH)、碱性磷酸酶(alkaline phosphatase,ALP)水平在阳性组显著升高(P < 0.05)；病灶的病理类型、最大径、体积及位置在两组间差异有统计学意义(P < 0.05)。多因素Logistic回归分析显示，术前血清PTH水平、病灶病理类型、位置及最大径与MIBI SPECT/CT显像结果阳性显著相关(P < 0.05)。结论  疑诊PHPT患者术前MIBI SPECT/CT显像结果受多重因素影响，术前血清PTH水平、病灶病理类型、位置及最大径是MIBI SPECT/CT显像结果的独立影响因素。

Abstract

Objective To explore the influencing factors of preoperative ^99mTc-MIBI single-photon emission computed tomography/computed tomography（SPECT/CT） in patients with suspected primary hyperparathyroidism (PHPT). Methods  A total of 257 patients with suspected PHPT who underwent preoperative MIBI SPECT/CT from January 2019 to August 2023 were retrospectively reviewed. The laboratory examination,pathological features,and imaging features between the positive and negative MIBI SPECT/CT groups were compared to each other. Multivariate Logistic regression analysis was used to identify the influencing factors of MIBI SPECT/CT results.  Results  The serum total calcium,parathyroid hormone（PTH）,and alkaline phosphatase（ALP） levels were significantly increased in the positive group than the negative group (P < 0.05); The pathological type,maximum diameter,volume,and location of the lesion showed statistically significant differences between the two groups (P < 0.05). Logistic regression analysis showed that preoperative serum PTH levels,pathological type,location,and maximum diameter of lesions were significantly correlated with positive MIBI SPECT/CT (P < 0.05). Conclusion  The preoperative MIBI SPECT/CT in patients with suspected PHPT were affected by multiple factors. The preoperative serum PTH level,pathological type,location and the maximum diameter of the lesion were independent factors for MIBI SPECT/CT. 

关键词

原发性甲状旁腺功能亢进症（PHPT） / ^99mTc-甲氧基异丁基异腈（MIBI） / SPECT/CT

Key words

primary hyperparathyroidism (PHPT) / ^99mTc-methoxyisobutylisonitrile(MIBI) / single-photon emission computed tomography/computed tomography（SPECT/CT）