SPECT与TM联检对NSCLC骨转移诊断的探讨  

Study on the diagnostic value of SPECT whole body bone imaging combined with the detection of tumor markers in bone metastases of NSCLC

作　　者：王鲁华[1] 李俊雄[1] 林琛[1] 方琳丽[1] 麦芒[1] 

机构地区：[1]汕头大学医学院第一附属医院核医学科,广东汕头515041

出　　处：《中国热带医学》2006年第7期1197-1199,共3页China Tropical Medicine

摘　　要：目的研究运用全身骨显像(SPECT whole body bone imaging),对非小细胞肺癌(Non-small-cell lung cancer,NSCLC)骨转移与未转移患者明确临床诊断及肿瘤标志物(Tumour Markers)的优化组合检测,探索在早期骨转移临床诊断中的作用。方法对113例NSCLC患者应用99mTc-亚甲基二膦酸盐(99mTc-MDP)进行全身骨显像。并分别采用化学发光免疫分析法检测血清CEA,和免疫放射分析法检测CA-50、CA15-3血清检查。结果NSCLC 113例患者提示为60.2%(68例)出现骨转移,其中多发转移灶58例,单发转移灶10例。提示为39.8%(45例)肺癌患者未出现转移。68例骨转移肺癌患者与45例未转移者CEA对照比较有极显著性意义(P<0.001);CA-50对照比较(P<0.05)差异有显著性;CA15-3骨转移患者差异显著高于未转移(P<0.01);68例骨转移与45例未转移CEA、CA-50和CA15-3血清检测浓度明显高于肺良性病变组,差异显著。结论NSCLC易发生骨转移,以多发性和溶骨性损害为特征,其中腺癌骨转移发生率较高。好发部位为胸部占50%(34/68),胸部又以肋骨最多见占79.4%(27/34)。骨转移患者与TM有着密切关系,提示TM优化组合检测,可弥补全身骨显像的假阴性率,提高临床诊断NSCLC骨转移的阳性率,有效监测肺癌早期骨转移一项辅助诊断指标。Objective To investigate the utilization of SPECT whole body bone imaging on confirmation of the clinical diagnosis of the bone metastases in patients with non - small - cell lung cancer （NSCLC） and evaluate the diagnostic results of optimized combination with the detection of tumor markers and SPECT whole body bone imaging on bone metastases at early stage. Methods 113 NSCLC patients were examined with whole body bone imaging using 99mTc - MDP as developer. Besides, serum CEA were measured with ehenilumineseenee immunoassay as well as serum CA- 50 and CA15 - 3 with immunoradiometrie assay in 113 eases of NSCLC and 42 eases of benign pulmonary disease. Results 68 of the 113 NSCLC patients were bone diffusers with a positive rate of 60. 2% including multi - metastasis in 28 eases, singular- metastasis in 10 eases. Imaging examination suggested osteolytie destruction chiefly. 7 NSCLC patients had malignant pleural effusion, of which abnormal radioactivity concentration locally and found bone metastases in 5 eases, the focus of bone metastases were super bone images in 4 eases. The 45 remainders（ 39.8% ） didn＇t show any metastasis. There were exceeding significant difference （ P 〈 0.001 ） between the 68 NSCLC patients with bone metastases and the 45 patients without bone metastases when compared with CEA, and significant difference （ P 〈 0.05） when compared with CA - 50. The levels of CA15 - 3 in patients with bone metastases were significantly higher than those in the group without metastasis （ P 〈 0.01 ）. The levels of CEA,CA - 50 and CA15 - 3 in the 5 eases with malignant pleural effusion showed radioactivity distributing concentration and the 4eases with super bone images were all greater than 936ng/ml, 190U/m and 210U/m, respectively. The levels of CEA,CA -50 and CA15- 3 in the 113 patients with NSCLC were significantly higher than those in the group with benign lung diseases. Conclusion Bone metastases in none small cell lung cancer is familiar and characterized by multiple osteoly

关 键 词：非小细胞肺癌 骨转移 SPECT全身骨显像 肿瘤标志物 

分 类 号：R73-37[医药卫生—肿瘤]