Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany.
Department of Nephrology and Hypertension, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
Oral Radiol. 2023 Jan;39(1):125-132. doi: 10.1007/s11282-022-00613-2. Epub 2022 May 5.
The present radiological observational controlled study aims to evaluate the impact of secondary hyperparathyroidism (SHPT) due to chronic kidney disease (CKD) as well as the duration of dialysis on the mineralization of the mandible by standardized qualitative evaluation of digital panoramic radiographs.
Panoramic radiographs of CKD patients with SHPT and healthy controls were used for the qualitative analysis of the mandibular cortical index (MCI), the trabecular bone pattern (TBP), and calcification and resorption foci. Radiomorphometric indices were correlated to biochemical parameters and the duration of dialysis using the Spearman Rho test. Group comparisons were conducted using the Mann-Whitney U test and Fisher's exact test at a significance level of α ≤ 0.05. Interrater reliability of two physicians was estimated using Cohen's kappa.
Inclusion and exclusion criteria were fulfilled by N = 41 patients. Statistically significant differences in the MCI (p < 0.001) as well as the TBP (p = 0.002) could be detected for the experimental group in comparison to the healthy control group. Focusing on calcification and resorption foci, no statistically significant difference could be detected between the groups (p = 0.244). The level of the detected parathyroid hormone (PTH) significantly correlated with TBP (Rho = 0.338; p = 0.031), while no significant relationship between TBP and the duration of the dialysis could be found.
Patients with SHPT due to CKD show statistically significant bone changes in the panoramic radiograph, whereby the grade of trabecular bone change correlates to PTH values.
本放射影像学观察性对照研究旨在通过对数字化全景片的定性评估，评估慢性肾脏病（CKD）继发甲状旁腺功能亢进症（SHPT）以及透析时间对下颌骨矿化的影响。
对伴有 SHPT 的 CKD 患者和健康对照者的全景片进行下颌皮质指数（MCI）、骨小梁模式（TBP）、钙化和吸收灶的定性分析。采用 Spearman Rho 检验将放射形态计量学指标与生化参数和透析时间进行相关分析。采用 Mann-Whitney U 检验和 Fisher 确切概率法在显著性水平α≤0.05 时进行组间比较。采用 Cohen's kappa 评估两名医师的组内一致性。
纳入和排除标准符合要求的患者共 41 名。与健康对照组相比，实验组的 MCI（p<0.001）和 TBP（p=0.002）存在统计学差异。在钙化和吸收灶方面，两组间无统计学差异（p=0.244）。检测到的甲状旁腺激素（PTH）水平与 TBP 呈显著相关（Rho=0.338；p=0.031），而 TBP 与透析时间之间无显著相关性。
SHPT 导致 CKD 的患者在全景片中显示出统计学上显著的骨改变，其中骨小梁变化的程度与 PTH 值相关。
