Vulpio Carlo, Bossola Maurizio, De Gaetano Annamaria, Maresca Giulia, Di Stasio Enrico, Spada Pier Luigi, Romitelli Federica, Luciani Giovanna, Castagneto Marco
Istituto Clinica Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italia.
Am J Nephrol. 2008;28(4):589-97. doi: 10.1159/000116875. Epub 2008 Feb 14.
The role ofparathyroid glands (PTG) ultrasonography (US) in hemodialysis patients with secondary hyperparathyroidism (SHPT) is still controversial. The present study aimed at evaluating the relationship between US findings and SHPT degree as well as therapeutic outcome.
Twenty hemodialysis patients with moderate SHPT and 15 with severe SHPT underwent US to assess the PTG number, maximum longitudinal diameter (MLD), structural (1-hypoechoic, 2-slight heterogeneous, 3-high heterogeneous, 4-nodular) and vascular patterns (1-slight, 2-medium and 3-high).
PTG number, MLD and US patterns were correlated with iPTH levels. MLD of patients with moderate or severe SHPT was 7.2 +/- 2.3 and 15 +/- 5.1 mm (p < 0.001). Most patients with moderate SHPT showed a single PTG with an MLD <9 mm associated with 1-2 structural and vascular pattern, whereas patients with severe SHPT exhibited more than one PTG with MLD >9 mm and 3-4 structural and vascular patterns. Thirteen patients were responders to treatment and 22 nonresponders. In nonresponders, a higher number of PTG was observed as well as higher echostructural and vascular patterns. In 14 patients who underwent parathyroidectomy, no differences were found between PTG US MLD and pathology diameter. All PTG with evidence of 3-4 structural and vascular score at ultrasound showed nodular hyperplasia at pathological examination.
The adopted classification of US findings is correlated with SHPT degree and therapeutic outcome and might be an adjunctive predictive method useful to assess the SHPT severity and to plan the therapeutic strategy.
甲状旁腺（PTG）超声检查（US）在血液透析继发性甲状旁腺功能亢进（SHPT）患者中的作用仍存在争议。本研究旨在评估超声检查结果与SHPT程度以及治疗效果之间的关系。
20例中度SHPT血液透析患者和15例重度SHPT血液透析患者接受了超声检查，以评估PTG数量、最大纵向直径（MLD）、结构（1-低回声、2-轻度不均匀、3-高度不均匀、4-结节状）和血管模式（1-轻度、2-中度和3-高度）。
PTG数量、MLD和超声模式与iPTH水平相关。中度或重度SHPT患者的MLD分别为7.2±2.3和15±5.1mm（p<0.001）。大多数中度SHPT患者表现为单个PTG，MLD<9mm，伴有1-2种结构和血管模式，而重度SHPT患者表现为多个PTG，MLD>9mm，伴有3-4种结构和血管模式。13例患者治疗有反应，22例无反应。无反应者中，观察到PTG数量更多，回声结构和血管模式更高。14例行甲状旁腺切除术的患者中，PTG超声MLD与病理直径之间无差异。所有超声显示结构和血管评分为3-4的PTG在病理检查中均显示结节性增生。
所采用的超声检查结果分类与SHPT程度和治疗效果相关，可能是一种有助于评估SHPT严重程度和规划治疗策略的辅助预测方法。
