^99mTc-MIBI SPECT/CT联合临床在肾性继发性甲状旁腺功能亢进甲状旁腺切除术后骨饥饿综合征的应用

The application of ^99mTc-MIBI SPECT/CT combined clinical indicators on hungry bone syndrome after parathyroidectomy for renal secondary hyperparathyroidism

摘要

目的: 探讨^99m锝-甲氧基异丁基异腈(^99mTc-methoxyisobutylisonitrile，MIBI)单光子发射计算机断层显像/计算机断层扫描(single-photon emission computed tomography/computed tomography，SPECT/CT)显像甲状旁腺数目、术前生化指标及外周血炎症指数与肾性继发性甲状旁腺功能亢进(secondary hyperparathyroidism，SHPT)甲状旁腺切除术(parathyroidectomy，PTX)后骨饥饿综合征(hungry bone syndrome，HBS)的关系。方法: 回顾性分析2014年6月—2025年3月南通大学附属江阴医院成功行PTX的113例肾性SHPT患者的临床与影像资料，根据PTX术后是否发生HBS分为HBS组及非HBS组。比较两组间各指标的差异，应用多因素Logistic回归分析HBS的危险因素。采用受试者工作特征(receiver operating characteristic，ROC)曲线确定最佳截断值。结果: 113例中HBS组63例，非HBS组50例。两组间年龄[(47.4±10.8)岁 vs.(54.1±9.2)岁，P=0.001]、术前碱性磷酸酶(alkaline phosphatase，ALP)[322.70(191.00，636.10)U/Lvs. 159.05(122.85，221.88)U/L，P<0.001]、术前甲状旁腺激素[171.10(114.00，227.30)pmol/L vs. 120.95(98.40，163.18)pmol/L，P=0.003]、术前校正钙[2.43(2.24，2.53)mmol/L vs. 2.51(2.39，2.61)mmol/L，P=0.024]、SPECT/CT显像甲状旁腺≥4枚[74.6%(47/63)vs. 38.0%(19/50)，P<0.001]及预后营养指数(prognostic nutritional index，PNI)[49.95(46.20，52.00) vs. 46.60(43.74，50.10)，P=0.003]差异均有统计学意义。多因素Logistic回归分析示术前ALP(OR=1.005，95%CI：1.002~1.009，P=0.002)、SPECT/CT显像甲状旁腺≥4枚(OR=3.166，95%CI：1.235~8.113，P=0.016)及PNI(OR=1.112，95%CI：1.013~1.221，P=0.026)为HBS的独立影响因素。ROC曲线确定术前ALP及PNI的最佳截断值为278.0 U/L、44.925。术前ALP≥278.0 U/L、SPECT/CT显像甲状旁腺≥4枚及PNI≥44.925联合应用诊断HBS的灵敏度为98.4%，优于单独应用，差异有统计学意义(P均<0.05)。结论: 术前ALP、SPECT/CT显像甲状旁腺≥4枚及PNI为肾性SHPT术后HBS的独立影响因素；联合术前ALP≥278.0 U/L、SPECT/CT显像≥4枚及PNI≥44.925诊断HBS灵敏度高，具有良好的临床应用价值。

Abstract

Objective: To investigate the relationship between the number of parathyroid gland on ^99mTc-methoxyisobutylisonitrile(MIBI)single-photon emission computed tomography/computed tomography(SPECT/CT)，preoperative laboratory parameters，peripheral blood inflammatory markers on bone hungry syndrome(HBS)after parathyroidectomy(PTX)in patients with renal secondary hyperparathyroidism(SHPT). Methods: The clinical and imaging data of 113 renal SHPT patients who underwent PTX in the Affiliated Jiangyin Hospital of Nantong University from Jun 2014 to Mar 2025 were retrospectively analyzed. The patients were divided into the HBS group and non-HBS group based on whether occurred HBS. Differences in various indices between the two groups were compared，multivariate logistic regression was used to analyze the influencing factors of HBS. The receiver operating characteristic(ROC)curve was used to determine the optimal cut-off value. Results: Of all 113 patients，there were 63 patients in the HBS group and 50 patients in the non-HBS group. There were significant differences in age[(47.4±10.8)years vs.(54.1±9.2)years，P=0.001]，preoperative alkaline phosphatase(ALP)[(322.70(191.00，636.10)U/L vs. 159.05(122.85，221.88)U/L，P<0.001]，preoperative parathyroid hormone[171.10(114.00，227.30)pmol/L vs. 120.95(98.40，163.18)pmol/L，P=0.003]，preoperative corrected calcium[2.43(2.24，2.53)mmol/L vs. 2.51(2.39，2.61)mmol/L，P=0.024]，the number of SPECT/CT parathyroid gland≥4[74.6%(47/63)vs. 38.0%(19/50)，P<0.001]，and prognostic nutritional index(PNI)[49.95(46.20，52.00)vs. 46.60(43.74，50.10)，P=0.003]between the two groups. Multivariate logistic regression showed that preoperative ALP(OR=1.005，95%CI：1.002-1.009，P=0.002)，the number of SPECT/CT parathyroid gland≥4(OR=3.166，95%CI：1.235-8.113，P=0.016)，and PNI(OR=1.112，95%CI：1.013-1.221，P=0.026)were independent risk factors for HBS. The ROC curve determined the optimal cut-off values of preoperative ALP and PNI as 278.0 U/L and 44.925. The combination of preoperative ALP≥278.0 U/L，the number of SPECT/CT parathyroid gland≥4 and PNI≥44.925 achieved sensitivity of 98.4% for diagnosing HBS，which were higher than individual indicator(allP<0.05). Conclusion: The preoperative ALP，the number of SPECT/CT parathyroid gland≥4，and PNI were independent influencing factors for HBS，combined preoperative ALP≥278.0 U/L，the number of SPECT/CT parathyroid gland≥4 and PNI≥44.925 demonstrates high sensitivity in diagnosing HBS，thus have good clinical value.

关键词

继发性甲状旁功能亢进症 / ^99mTc-MIBI SPECT/CT / 甲状旁腺激素 / 骨饥饿综合征 / 炎症标志物

Key words

secondary hyperparathyroidism / ^99mTc-MIBI SPECT/CT / parathyroid hormone / hungry bone syndrome / inflammatory marker

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基金资助

江阴市“暨阳名医”领航专家入库团队