Boyd J C, Ladenson J H
Am J Med. 1984 Nov;77(5):863-72. doi: 10.1016/0002-9343(84)90525-4.
Eighteen laboratory tests were compared in the differentiation of primary hyperparathyroidism from hypercalcemia associated with malignancy. Statistical comparisons of the test results were carried out in four patient groups and two control groups. The patient groups evaluated were those with confirmed primary hyperparathyroidism, those with malignancy with hypercalcemia, those with malignancy without hypercalcemia, and those with surgically cured primary hyperparathyroidism. These groups allowed determination of the relative diagnostic values of the tests and a rationale for their value. After exclusion of patients with renal failure from the patient and control groups, these data indicated that the laboratory tests with the greatest differential diagnostic value, in order of efficacy, were: albumin, carboxy-terminal parathyroid hormone, venous pH, cholesterol, chloride, alkaline phosphatase, phosphorus, and the chloride/phosphate ratio. Hemoglobin, hematocrit, and red blood cell count also had some value, particularly in male patients. However, none of these tests individually achieved better than an 81 percent classification accuracy. With application of logistic discriminant analysis, only three tests--albumin, parathyroid hormone, and chloride--were identified as statistically significant in jointly improving the diagnostic separation between these two patient groups. Although the 94.4 percent classification accuracy achieved by use of these three variables in a logistic discriminant function was better than that obtained with any individual variable, incorrect classification was still a significant problem, particularly in the case of patients with malignancy and high concentrations of parathyroid hormone. With the exception of albumin and chloride measurements, the commonly available ancillary laboratory tests proposed to aid this differential diagnosis do not give any more information than the analysis of parathyroid hormone alone and merely add to the increased cost of medical care.
对18项实验室检测在鉴别原发性甲状旁腺功能亢进与恶性肿瘤相关高钙血症方面进行了比较。在四个患者组和两个对照组中对检测结果进行了统计学比较。所评估的患者组包括确诊为原发性甲状旁腺功能亢进的患者、伴有高钙血症的恶性肿瘤患者、不伴有高钙血症的恶性肿瘤患者以及手术治愈的原发性甲状旁腺功能亢进患者。这些组有助于确定检测的相对诊断价值及其价值依据。在将肾衰竭患者从患者组和对照组中排除后，这些数据表明，按有效性排序，具有最大鉴别诊断价值的实验室检测为：白蛋白、甲状旁腺激素羧基末端、静脉血pH值、胆固醇、氯、碱性磷酸酶、磷以及氯/磷比值。血红蛋白、血细胞比容和红细胞计数也有一定价值，尤其是在男性患者中。然而，这些检测中没有一项单独的分类准确率能超过81%。应用逻辑判别分析，仅白蛋白、甲状旁腺激素和氯这三项检测被确定在联合改善这两组患者的诊断区分方面具有统计学意义。尽管在逻辑判别函数中使用这三个变量所达到的94.4%的分类准确率优于任何单个变量所获得的准确率，但错误分类仍然是一个重大问题，尤其是在伴有高浓度甲状旁腺激素的恶性肿瘤患者中。除白蛋白和氯的测量外，为辅助这种鉴别诊断而提议的常用辅助实验室检测所提供的信息并不比单独分析甲状旁腺激素更多，只是增加了医疗费用。
