Abstract：
OBJECTIVE: The main purpose of this study was to explore the diagnostic performance of the Ca∗Cl/P ratio for primary hyperparathyroidism (PHPT), especially normocalcaemic PHPT (NPHPT), to assist health care providers in making reliable and rapid clinical identifications.
METHODS: From January 1, 2013, to March 31, 2023, 230 PHPT patients, including 65 with NPHPT and 230 sex- and age-matched controls, were enrolled in this retrospective study. Differences between hypercalcaemic PHPT (HPHPT) and NPHPT and between them and their respective controls were analyzed. The diagnostic accuracy of the Ca∗Cl/P ratio, Ca/P ratio, Cl/P ratio and albumin-corrected calcium was assessed by the area under the receiver operating characteristic curve.
RESULTS: Compared with corresponding controls, NPHPT and HPHPT patients both had significantly higher Ca ∗ Cl/P ratios (271.64 ± 51.74 vs 192.71 ± 26; 419.91 ± 139.11 vs 199.14 ± 36.75, P < .001). In the overall cohort, the ROC-AUC of the Ca∗Cl/P ratio (0.964, 95% CI = 0.943-0.979) for diagnosis of PHPT patients was superior to albumin-corrected calcium (0.959, 95% CI = 0.934-0.973), the Ca/P ratio (0.956, 95% CI = 0.934-0.973), and the Cl/P ratio (0.923, 95% CI = 0.895-0.946). A Ca ∗ Cl/P ratio above 239.17 mmol/L, with sensitivity (0.952), specificity (0.922), PPV (0.924), NPV (0.951) and accuracy (0.937), can distinguish PHPT patients from healthy individuals. Furthermore, the Ca ∗ Cl/P ratio yielded a sensitivity of 0.831, specificity of 0.938, PPV of 0.931, NPV of 0.847 and accuracy of 0.885 for NPHPT.
CONCLUSIONS: The Ca∗Cl/P ratio provides excellent diagnostic power for diagnosis of PHPT, especially NPHPT.
METHODS: From January 1, 2013, to March 31, 2023, 230 PHPT patients, including 65 with NPHPT and 230 sex- and age-matched controls, were enrolled in this retrospective study. Differences between hypercalcaemic PHPT (HPHPT) and NPHPT and between them and their respective controls were analyzed. The diagnostic accuracy of the Ca∗Cl/P ratio, Ca/P ratio, Cl/P ratio and albumin-corrected calcium was assessed by the area under the receiver operating characteristic curve.
RESULTS: Compared with corresponding controls, NPHPT and HPHPT patients both had significantly higher Ca ∗ Cl/P ratios (271.64 ± 51.74 vs 192.71 ± 26; 419.91 ± 139.11 vs 199.14 ± 36.75, P < .001). In the overall cohort, the ROC-AUC of the Ca∗Cl/P ratio (0.964, 95% CI = 0.943-0.979) for diagnosis of PHPT patients was superior to albumin-corrected calcium (0.959, 95% CI = 0.934-0.973), the Ca/P ratio (0.956, 95% CI = 0.934-0.973), and the Cl/P ratio (0.923, 95% CI = 0.895-0.946). A Ca ∗ Cl/P ratio above 239.17 mmol/L, with sensitivity (0.952), specificity (0.922), PPV (0.924), NPV (0.951) and accuracy (0.937), can distinguish PHPT patients from healthy individuals. Furthermore, the Ca ∗ Cl/P ratio yielded a sensitivity of 0.831, specificity of 0.938, PPV of 0.931, NPV of 0.847 and accuracy of 0.885 for NPHPT.
CONCLUSIONS: The Ca∗Cl/P ratio provides excellent diagnostic power for diagnosis of PHPT, especially NPHPT.
摘要：
目的：本研究的主要目的是探讨Ca*Cl/P比值对原发性甲状旁腺功能亢进（PHPT）的诊断性能，尤其是正常钙血症性原发性甲状旁腺功能亢进（NPHPT），协助医疗保健提供者进行可靠和快速的临床鉴定。
方法：从2013年1月1日至2023年3月31日，230名PHPT患者，包括65名NPHPT和230名性别和年龄匹配的对照，参加了这项回顾性研究。分析了高钙血症性原发性甲状旁腺功能亢进（HPHPT）和NPHPT之间以及它们与各自对照之间的差异。Ca*Cl/P比值的诊断准确性，Ca/P比,通过受试者工作特征曲线下面积(ROC-AUC)评估Cl/P比率和白蛋白校正的钙。
结果：与相应的对照相比，NPHPT和HPHPT患者的Ca*Cl/P比值均显着较高（271.64±51.74vs.192.71±26；419.91±139.11vs.199.14±36.75，p<0.001)。在整个队列中，用于诊断PHPT患者的Ca*Cl/P比的ROC-AUC（0.964，95％CI=0.943-0.979）优于白蛋白校正钙（0.959，95％CI=0.934-0.973），钙/磷比值(0.956，95%CI=0.934-0.973)，和Cl/P比（0.923，95%CI=0.895-0.946）。Ca*Cl/P比值大于239.17mmol/L，灵敏度（0.952），特异性（0.922），PPV（0.924），净现值(0.951)和准确度(0.937)，可以区分PHPT患者和健康个体。此外，Ca*Cl/P比值对NPHPT的敏感性为0.831，特异性为0.938，PPV为0.931，NPV为0.847，准确性为0.885。
结论：Ca*Cl/P比值为PHPT的诊断提供了极好的诊断能力，尤其是NPHPT。
方法：从2013年1月1日至2023年3月31日，230名PHPT患者，包括65名NPHPT和230名性别和年龄匹配的对照，参加了这项回顾性研究。分析了高钙血症性原发性甲状旁腺功能亢进（HPHPT）和NPHPT之间以及它们与各自对照之间的差异。Ca*Cl/P比值的诊断准确性，Ca/P比,通过受试者工作特征曲线下面积(ROC-AUC)评估Cl/P比率和白蛋白校正的钙。
结果：与相应的对照相比，NPHPT和HPHPT患者的Ca*Cl/P比值均显着较高（271.64±51.74vs.192.71±26；419.91±139.11vs.199.14±36.75，p<0.001)。在整个队列中，用于诊断PHPT患者的Ca*Cl/P比的ROC-AUC（0.964，95％CI=0.943-0.979）优于白蛋白校正钙（0.959，95％CI=0.934-0.973），钙/磷比值(0.956，95%CI=0.934-0.973)，和Cl/P比（0.923，95%CI=0.895-0.946）。Ca*Cl/P比值大于239.17mmol/L，灵敏度（0.952），特异性（0.922），PPV（0.924），净现值(0.951)和准确度(0.937)，可以区分PHPT患者和健康个体。此外，Ca*Cl/P比值对NPHPT的敏感性为0.831，特异性为0.938，PPV为0.931，NPV为0.847，准确性为0.885。
结论：Ca*Cl/P比值为PHPT的诊断提供了极好的诊断能力，尤其是NPHPT。
