摘要
目的探讨血清甲状旁腺素(PTH)对原发性醛固酮增多症(PA)的诊断价值和最佳诊断切点。方法收集2017年1月1日至2019年12月31日解放军总医院第一医学中心内分泌科收治的肾上腺占位患者的临床资料,根据临床表现和内分泌功能评估结果分为两组:PA组和肾上腺无功能瘤(NFA)组,分析比较两组患者的临床和实验室特征,采用logistic回归模型分析PA患者PTH升高的潜在危险因素,应用受试者工作特征(ROC)曲线评价PTH对PA的诊断价值并找出最佳切点。结果共纳入患者773例,其中PA组356例,年龄(50±11)岁,男性占57.0%(203例);NFA组417例,年龄(51±12)岁,男性占52.5%(219例)。PA组PTH水平[63.1(48.4,80.3)比41.7(34.1,51.7)ng/L]及PTH升高者所占比例(47.8%比7.2%)均高于NFA组(均P<0.05)。多因素logistic回归分析显示,患有PA及维生素D缺乏为PTH升高的潜在危险因素(均P<0.05)。ROC曲线分析显示,维生素D缺乏状态下,PTH筛查PA的临界值为56.44 ng/L,灵敏度为66.5%,特异度为83.0%;维生素D不缺乏状态下,其筛查的临界值为48.81 ng/L,灵敏度为70.5%,特异度为72.6%。结论PA患者PTH分泌增加,血清PTH水平可作为PA筛查有价值的指标之一。
Objective To explore the value of serum parathyroid hormone(PTH)in the diagnosis of primary aldosteronism(PA)and to investigate an optimal cut-off of serum PTH to distinguish PA from nonfunctional adrenal tumor(NFA).Methods The clinical data of patients with adrenal incidentaloma in Chinese PLA General Hospital from January 1,2017 to December 31,2019 were collected.The data of PA and NFA by clinical characteristics and evaluation on endocrine function were retrospectively analyzed.The logistic regression model was used to find the potential risk factors of elevated PTH.The receiver operating characteristic(ROC)curve was used to evaluate the efficacy of PTH in diagnosis of PA and to explore the best cut-off value.Results A total of 773 patients were included.There were 356 PA patients(203 males,57.0%),aged(50±11)years and 417 NFA patients(219 males,52.5%),aged(51±12)years.The serum PTH level in patients with PA was significantly higher than that in patients with NFA[63.1(48.4,80.3)ng/L vs 41.7(34.1,51.7)ng/L,P<0.05],as well as the proportion of patients with elevated PTH level(47.8%vs 7.2%,P<0.05).Logistic regression analysis showed that having PA and deficiency of Vitamin D were risk factors for PTH elevation(both P<0.05).The ROC curve showed that the best cut-off value of PTH for the diagnosis of PA in patients with vitamin D deficiency was 56.44 ng/L,with a sensitivity of 66.5%and a specificity of 83.0%,and that in patients with normal vitamin D was 48.81 ng/L,with a sensitivity of 70.5%and a specificity of 72.6%.Conclusions Patients with PA tend to show increased levels of serum PTH compared with NFA patients.The level of serum PTH can be used as one of the valuable indexes in screening of PA.
作者
刘永菊
杨国庆
裴育
窦京涛
吕朝晖
杜锦
巴建明
母义明
Liu Yongju;Yang Guoqing;Pei Yu;Dou Jingtao;Lyu Zhaohui;Du Jin;Ba Jianming;Mu Yiming(Department of Endocrinology,Chinese PLA General Hospital,Beijing 100853,China;Department of Endocrinology,Hainan Hospital of PLA General Hospital,Sanya 572013,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2021年第34期2674-2680,共7页
National Medical Journal of China
关键词
醛固酮增多症
甲状旁腺素
灵敏度
特异度
诊断试验
Hyperaldosteronism
Parathyroid hormone
Sensitivity
Specificity
Diagnostic test
作者简介
通信作者:杨国庆,Email:endocrine301@126.com。
