中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (10): 540-544.doi: 10.3969/j.issn.1671-4091.2016.10.007

• 临床研究 • 上一篇    下一篇

声触诊组织量化成像技术对继发性甲状旁腺功能亢进的初步应用研究

郑华1,郑曙光1,徐岩2   

  1. 青岛大学医学院附属医院肾内科
  • 收稿日期:2016-04-12 修回日期:2016-08-01 出版日期:2016-10-12 发布日期:2016-10-10
  • 通讯作者: 徐岩 xuyanqyfy@126.com E-mail:xuyanqyfy@126.com
  • 基金资助:

    国家自然科学基金(81470973)

Application of virtual touch tissue imaging quantification on the secondary hyperparathyroidism

  • Received:2016-04-12 Revised:2016-08-01 Online:2016-10-12 Published:2016-10-10

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摘要： 目的通过声触诊组织量化成像(virtual touch tissue imaging quantification，VTIQ)技术来测量血液透析患者甲状旁腺组织剪切波速度(shear wave velocity，SWV)，以探讨VTIQ 在继发性甲状旁腺功能亢进(secondary hyperparathyroidism，SHPT)中的应用价值。方法正常对照组30 例选自青岛大学附属医院自愿接受甲状旁腺超声及VTIQ 检查医护人员。研究组107 例选自慢性肾脏病(chronic kidney disease，CKD)5 期血液透析患者，根据甲状旁腺激素(intact parathyroid hormone，
iPTH)测量值将其分为3 组：A 组(﹤300pg/ml)、B 组(300 pg/ml～800 pg/ml)、C 组(≥800 pg/ml)。应用超声VTIQ 技术测量SWV，通过组间比较、相关性检验及受试者工作特征曲线(receiver operator characteristic curve,ROC 曲线)分析不同组间SWV 差异及变化特征。结果通过比较组间SWV 值发现，A组(2.081±0.463)m/s 与正常对照组(1.978±0.303)m/s 差异无统计学意义(LSD-t=0.792；P=0.430)，B组(2.428±0.502)m/s、C 组(3.022±0.707)m/s 均较正常对照组增大(LSD-t=3.518, P=0.001; LSD-t=8.066, P＜0.001)，A、B 组，B、C 组，A、C 组SWV 组间差异有统计学意义(LSD-t=2.830, P=0.005; LSD-t=4.845, P＜0.001; LSD-t=7.571, P＜0.001) iPTH 与SWV 之间呈正相关(r=0.680，P＜0.001)。以iPTH 值300pg/ml 和800pg/ml 分别作为诊断SHPT 及手术的截断点，对SWV 进行ROC 分析发现其曲线下面积分别为0.798、0.842(均P＜0.001)，截断值为2.260 m/s、2.720 m/s，敏感度分别为79.17%、80.00%，特异度分别为77.14%、83.33%。结论VTIQ 技术测量甲状旁腺的SWV，可实现对CKD5 期血液透析患者SHPT 的无创定量评估。

关键词: 血液透析, 声脉冲辐射力成像, 声触诊组织量化成像技术, 继发性甲状旁腺功能亢进

Abstract: Objective To investigate the application of virtual touch tissue imaging quantification (VTIQ) on the secondary hyperparathyroidism (SHPT). Methods A total of 107 hemodialysis patients with chronic kidney disease were recruited as the research group and were divided into 3 groups according to the serum iPTH level, group A (>300pg/ml), group B (300pg/ml～800pg/ml), and group C (≥800pg/ml). Thirty volunteers served as healthy controls. VTIQ that determined the shear wave velocity (SWV) of the parathyroid glands was performed in the 4 groups. The differences and characteristics of SWV in different groups were analyzed by the performance of comparison among groups, correlation test, and receiver operator characteristic (ROC) curve. Result SWV had no statistical significance between group A and group control (LSDt= 0.792, P=0.430), but was significantly higher in group B than in group control (LSD- t=3.518, P=0.001), and in group C than in group control (LSD-t =8.066, P＜0.001). There were also significant differences in SWV between groups A and B (LSD- t=2.830, P=0.005), groups B and C (LSD- t=4.845, P＜0.001), and groups A and C (LSD-t=7.571, P＜0.001). SWV was positively correlated with iPTH (r=0.680, P＜0.001). When we set iPTH at 300 pg/ml as the cutoff value for the diagnosis of SHPT, and at 800 pg/ml as the cutoff value for surgical treatment of SHPT, the areas under ROC curve were 0.798 and 0.842 (P＜0.001), the SWV cutoff values were 2.260 m/s and 2.720 m/s, the sensitivity of SWV value were 79.17% and 80.00%, and the
specificity of SWV value were 77.14% and 83.33%, respectively. Conclusions VTIQ can noninvasively and quantitatively assess the changes of parathyroid gland in patients with SHPT

Key words: hemodialysis, acoustic radiation force impulse, virtual touch tissue imaging quantification, Secondary Hyperparathyroidism