超声引导下热消融治疗继发性甲状旁腺功能亢进：一项前瞻性多中心研究。

US-Guided Thermal Ablation for Secondary Hyperparathyroidism: A Prospective Multicenter Study.

作者信息

Liu Yang, Peng Cheng-Zhong, Chai Hui-Hui, Qian Lin-Xue, Wu Song-Song, Yu Ming-An, Li Shui-Ping, Zhang Jian-Tang, Shan Yue, Liu Fang-Yi, Sun Chong-Bing, Yang Zhi-Wei, Zhang Rui, Che Ying, Gao Shu-Hang, Yu Jie, Liang Ping

机构信息

From the Department of Interventional Ultrasound, the Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (Y.L., F.Y.L., J.Y., P.L.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (C.Z.P.); Graduate Department, Bengbu Medical College, Bengbu, Anhui, China (H.H.C.); Department of Ultrasound, Capital Medical University, Beijing Friendship Hospital, Beijing, China (L.X.Q.); Department of Ultrasonography, Fujian Provincial Hospital, Fuzhou, Fujian, China (S.S.W.); Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China (S.P.L., J.T.Z.); Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China (Y.S.); Weifang Peoples Hospital, Weifang, Shandong, China (C.B.S.); Daqing Oilfield General Hospital, Daqing, Liaoning, China (Z.W.Y., R.Z.); and Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (Y.C., S.H.G.).

出版信息

Radiology. 2025 Jan;314(1):e233104. doi: 10.1148/radiol.233104.

DOI:10.1148/radiol.233104

PMID:39772792

Abstract

Background Interest in microwave ablation (MWA) and radiofrequency ablation (RFA) use for treating secondary hyperparathyroidism (SHPT) is rising; however, ablation outcomes in patients with SHPT are not well characterized. Purpose To assess the response of parathyroid hormone (PTH), calcium, phosphorus, and alkaline phosphatase (ALP) levels to US-guided parathyroid MWA and RFA and the safety of these treatments in participants with SHPT. Materials and Methods This prospective multicenter cohort study, conducted from September 2017 to March 2022, included participants with SHPT. The primary end point was the proportion of participants achieving the target PTH level (≤585 pg/mL). The secondary end points included PTH, calcium, phosphorus, and ALP levels before ablation and time points for follow-up assessments after ablation (2 hours, 1 day, 1 month, 3 months, and 6 months, and then every 6 months) and complications and technical success rates. Mixed-effects logistic regression models were used to identify factors associated with treatment failure. Results A total of 215 participants (median age, 53 years [IQR, 43-60 years]; 109 [50.7%] male participants) were evaluated, and 183 (85.1%) achieved target PTH levels. Compared with baseline levels, there was an 85.9%, 6.3%, 15.3%, and 37.4% reduction in PTH, calcium, phosphorus, and ALP levels at 24 months after ablation, respectively. For major complications, one (0.5%) participant experienced persistent hoarseness, and severe hypocalcemia (<1.87 mmol/L) was present in 74 (34.4%) participants. After adjustments, predictors associated with treatment failure included the preablation PTH level (adjusted odds ratio [OR], 3.78; 95% CI: 1.19, 12.04; = .03), maximum tumor volume (adjusted OR, 5.02; 95% CI: 1.74, 14.53; = .003), and number of glands ablated (adjusted OR, 0.32; 95% CI: 0.11, 0.98; = .046). The prediction model showed good discrimination ability in the development and validation cohorts (area under the receiver operating characteristic curve, 0.78 [95% CI: 0.66, 0.90] and 0.73 [95% CI: 0.55, 0.91], respectively). Conclusion US-guided thermal ablation techniques were effective and safe treatments in participants with SHPT because they effectively reduced PTH, calcium, phosphorus, and ALP levels. © RSNA, 2025 See also the editorial by Gemmete in this issue.

摘要

背景用于治疗继发性甲状旁腺功能亢进（SHPT）的微波消融（MWA）和射频消融（RFA）的应用正受到越来越多的关注；然而，SHPT患者的消融结果尚未得到充分描述。目的评估甲状旁腺激素（PTH）、钙、磷和碱性磷酸酶（ALP）水平对超声引导下甲状旁腺MWA和RFA的反应以及这些治疗方法在SHPT参与者中的安全性。材料与方法这项前瞻性多中心队列研究于2017年9月至2022年3月进行，纳入了SHPT参与者。主要终点是达到目标PTH水平（≤585 pg/mL）的参与者比例。次要终点包括消融前的PTH、钙、磷和ALP水平以及消融后的随访评估时间点（2小时、1天、1个月、3个月和6个月，然后每6个月一次）以及并发症和技术成功率。使用混合效应逻辑回归模型来确定与治疗失败相关的因素。结果共评估了215名参与者（中位年龄53岁[四分位间距，43 - 60岁]；109名[50.7%]男性参与者），其中183名（85.1%）达到了目标PTH水平。与基线水平相比，消融后24个月时PTH、钙、磷和ALP水平分别降低了85.9%、6.3%、15.3%和37.4%。对于主要并发症，1名（0.5%）参与者出现持续性声音嘶哑，74名（34.4%）参与者出现严重低钙血症（<1.87 mmol/L）。调整后，与治疗失败相关的预测因素包括消融前PTH水平（调整后的比值比[OR]，3.78；95%置信区间：1.19，12.04；P = 0.03）、最大肿瘤体积（调整后的OR，5.02；95%置信区间：1.74，14.53；P = 0.003）以及消融的腺体数量（调整后的OR，0.32；95%置信区间：0.11，0.98；P = 0.046）。预测模型在开发队列和验证队列中显示出良好的区分能力（受试者操作特征曲线下面积分别为0.78[95%置信区间：0.66，0.90]和0.73[95%置信区间：0.55，0.91]）。结论超声引导下的热消融技术对SHPT参与者是有效且安全的治疗方法，因为它们能有效降低PTH、钙、磷和ALP水平。© RSNA，2025 另见本期Gemmete的社论。