超声引导下射频消融治疗三级甲状旁腺功能亢进症：前瞻性研究

IF 4.4 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Korean Journal of Radiology Pub Date : 2024-03-01 DOI:10.3348/kjr.2023.0176

Erya Deng, Tingting Jiang, Huihui Chai, Ning Weng, Hongfeng He, Zhengxian Zhang, Chengzhong Peng, Wenwen Yue, Huixiong Xu

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Ultimately, 36 patients with renal failure and 2 patients who underwent successful renal transplantation (male:female, 17:21; median age, 54.5 years) were enrolled. The follow-up time was 21.5 ± 19.0 months in the 36 patients with renal failure. In these 36 patients, iPTH levels were significantly decreased to 261.1 pg/mL at 48 months compared with the baseline value of 1284.9 pg/mL (P = 0.012). Persistent hyperparathyroidism, defined as iPTH levels maintained at > 585.0 pg/mL for 6 months after treatment, occurred in 4.0% of patients (1/25). Recurrent hyperparathyroidism, defined as iPTH levels > 585.0 pg/mL after 6 months, were 4.0% (1/25) and 0.0% (0/9) at 6 months and 4 years after treatment, respectively. In two patients with THPT after successful renal transplantation, iPTH decreased from the baseline value of 242.5 and 115.9 pg/mL to 171.0 and 62.0 pg/mL at 6 months after treatment. 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引用次数: 0

摘要

摘要前瞻性评估超声（US）引导下射频消融术（RFA）在三级甲状旁腺功能亢进症（THPT）中的疗效：2017年9月至2022年1月期间接受RFA治疗的THPT患者。RFA术后48个月内监测实验室参数，包括血清完整甲状旁腺激素（iPTH）水平，并与基线水平进行比较。RFA前后记录了与RFA相关的并发症以及甲状旁腺功能亢进相关临床症状的变化：本研究共招募了42名THPT患者。最终，36名肾衰竭患者和2名成功接受肾移植的患者（男女比例为17:21；中位年龄为54.5岁）被纳入研究。36 名肾衰竭患者的随访时间为 21.5 ± 19.0 个月。与基线值 1284.9 pg/mL 相比，这 36 名患者的 iPTH 水平在 48 个月时显著下降至 261.1 pg/mL（P = 0.012）。4.0%的患者（1/25）出现了持续性甲状旁腺功能亢进，即治疗后6个月内iPTH水平仍大于585.0 pg/mL。复发性甲状旁腺功能亢进的定义是 6 个月后 iPTH 水平> 585.0 pg/mL，在治疗后 6 个月和 4 年分别为 4.0% (1/25)和 0.0% (0/9)。在两名成功接受肾移植的 THPT 患者中，iPTH 分别从 242.5 和 115.9 pg/mL 的基线值降至治疗后 6 个月时的 171.0 和 62.0 pg/mL。除10.5%（4/38）患者出现永久性低钙血症外，所有并发症均在消融术后6个月内缓解，无需医疗干预。总体症状恢复率为 58.8%（10/17）。治疗后，与甲状旁腺功能亢进相关的骨痛、关节痛和皮肤瘙痒的严重程度评分有所改善（P < 0.05）：结论：在治疗甲状旁腺功能亢进症相关临床症状方面，US引导下的RFA是一种有效且安全的手术替代疗法。

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Ultrasound-Guided Radiofrequency Ablation in Tertiary Hyperparathyroidism: A Prospective Study.

Objective: To prospectively evaluate the outcomes of ultrasound (US)-guided radiofrequency ablation (RFA) in tertiary hyperparathyroidism (THPT).

Materials and methods: Patients with THPT underwent RFA between September 2017 and January 2022. Laboratory parameters, including serum intact parathyroid hormone (iPTH) levels, were monitored for 48 months after RFA and compared with the levels at baseline. Complications related to RFA and changes in hyperparathyroidism-related clinical symptoms were recorded before and after RFA.

Results: A total of 42 patients with THPT were recruited for this study. Ultimately, 36 patients with renal failure and 2 patients who underwent successful renal transplantation (male:female, 17:21; median age, 54.5 years) were enrolled. The follow-up time was 21.5 ± 19.0 months in the 36 patients with renal failure. In these 36 patients, iPTH levels were significantly decreased to 261.1 pg/mL at 48 months compared with the baseline value of 1284.9 pg/mL (P = 0.012). Persistent hyperparathyroidism, defined as iPTH levels maintained at > 585.0 pg/mL for 6 months after treatment, occurred in 4.0% of patients (1/25). Recurrent hyperparathyroidism, defined as iPTH levels > 585.0 pg/mL after 6 months, were 4.0% (1/25) and 0.0% (0/9) at 6 months and 4 years after treatment, respectively. In two patients with THPT after successful renal transplantation, iPTH decreased from the baseline value of 242.5 and 115.9 pg/mL to 171.0 and 62.0 pg/mL at 6 months after treatment. All complications resolved within 6 months of ablation without medical intervention, except in 10.5% (4/38) patients with permanent hypocalcemia. The overall symptom recovery rate was 58.8% (10/17). The severity scores for bone pain, arthralgia, and itchy skin associated with hyperparathyroidism improved after treatment (P < 0.05).

Conclusion: US-guided RFA is an effective and safe alternative to surgery in the treatment of patients with TPTH and improves hyperparathyroidism-related clinical symptoms.

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来源期刊

Korean Journal of Radiology 医学-核医学

CiteScore

10.60

自引率

12.50%

发文量

141

审稿时长

1.3 months

期刊介绍： The inaugural issue of the Korean J Radiol came out in March 2000. Our journal aims to produce and propagate knowledge on radiologic imaging and related sciences. A unique feature of the articles published in the Journal will be their reflection of global trends in radiology combined with an East-Asian perspective. Geographic differences in disease prevalence will be reflected in the contents of papers, and this will serve to enrich our body of knowledge. World''s outstanding radiologists from many countries are serving as editorial board of our journal.