Objective: To evaluate the potential factors influencing the parathyroid autofluorescence intensity of near-infrared fluorescent (NIRF) and further value of NIRF in identifying the parathyroid during surgery. Methods: The clinical data of 51 patients who underwent thyroid or parathyroid surgery in the Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University from April to June 2019 were retrospectively analyzed, including 16 males and 35 females, aged 18 to 74 years.The fluorescence intensity (FI) of the parathyroid glands, thyroid glands and background, and the number of parathyroid glands detected by NIRF and white light were measured. Variance analysis, two independent samples t test and Spearman rank correlation analysis were used to analyze the relationship between standardized parathyroid FI and clinical variables. Chi square test was used to analyze the difference of parathyroid detection rate between NIRF and white light. Results: In the 51 patients, the mean standardized parathyroid FI was greater than the standardized thyroid FI (1.72 ± 0.68 vs. 1.25 ± 0.40, t=6.555, P<0.001). The standardized parathyroid FI was not associated with gender, age, operation type, BMI, preoperative serum Ca(2+), parathyroid hormone and calcitonin (all P>0.05), but it was associated with disease type (F=2.636, P<0.05). The mean standardized parathyroid FI of SHPT was lower than that of PTC, PTC with nodular goiter or NG(0.70±0.28 vs. 1.86±0.70, 1.69±0.49, 1.64±0.44, t value was 3.023, -1.129,-2.019, respectively, all P<0.05). There was no difference in the standardized parathyroid FI between SHPT and PHPT (1.34±0.18, t=1.218, P>0.05). There was no difference in standardized parathyroid FI between PHPT, PTC, NG, and PTC with NG(all P>0.05). Except for 3 cases of SHPT, 117 parathyroid glands were detected by NIRF and 101 parathyroid glands were detected by white light. The detection rate of parathyroid glands detected by NIRF was higher than that detected by white light (98.32% vs. 84.87%, χ(2)=13.974, P<0.001). In SHPT, the detection rate of parathyroid gland by NIRF was 25.00%. Conclusions: Except SHPT, parathyroid FI is not affected by other clinical variables. NIRF can improve the detection rate of parathyroid glands during operation.
目的： 研究近红外荧光（near-infrared fluorescent，NIRF）下甲状旁腺自体荧光强度（fluorescence intensity，FI）的影响因素，进一步评估NIRF技术在术中辨认甲状旁腺的价值。 方法： 回顾性分析2019年4—6月于郑州大学第一附属医院甲状腺外科行甲状腺或甲状旁腺手术的51例患者的临床资料，其中男16例，女35例，年龄18~74岁。测量术中甲状旁腺、甲状腺及背景在NIRF下的FI，并统计NIRF和白光检出甲状旁腺的枚数，用方差分析、两独立样本t检验和Spearman秩相关分析标准化甲状旁腺FI与临床变量的关系，用χ(2)检验分析NIRF和白光对甲状旁腺检出率的差异。 结果： 51例患者中，标准化甲状旁腺FI大于标准化甲状腺FI（1.72±0.68比1.25±0.40，t=6.555，P<0.001）。标准化甲状旁腺FI与性别、年龄、手术方式、体质量指数、术前血Ca(2+)、甲状旁腺激素和降钙素无关（P值均>0.05）。标准化甲状旁腺FI与疾病类型有关（F=2.636，P<0.05），继发性甲状旁腺功能亢进（secondary hyperparathyroidism，SHPT）的标准化甲状旁腺FI（0.70±0.28）低于甲状腺乳头状癌（papillary thyroid cancer，PTC）（1.86±0.70）、PTC合并结节性甲状腺肿（nodular goiter，NG）（1.69±0.49）和NG（1.64±0.44），差异有统计学意义（t值分别为3.023、-1.129、-2.019，P值均<0.05），与原发性甲状旁腺功能亢进（primary hyperparathyroidism，PHPT）FI（1.34±0.18）差异无统计学意义（t=1.218，P>0.05）。PHPT、PTC、NG和PTC合并NG的标准化甲状旁腺FI，两两之间差异均无统计学意义（P值均>0.05）。除外3例SHPT，NIRF对甲状旁腺的检出率高于白光下的检出率[98.32%（117/119）比84.87%（101/119），χ(2)=13.974，P<0.001]。在SHPT中，NIRF对甲状旁腺的检出率为25.00%（3/12）。 结论： 近红外荧光下甲状旁腺FI不受其他临床变量的影响，除SHPT外，NIRF技术可提高术中甲状旁腺的识别能力。.
Keywords: Detection rate; Fluorescence intensity; Influencing factor; Parathyroid glands.