核素骨显像联合血清前列腺特异性抗原游离水平与总量比值测定对前列腺癌骨转移诊断的临床意义  

Clinical value of ^(99m)Tc-MDP bone imaging combined with serum FPSA/TPSA ratio for the diagnosis of bone metastasis in prostate cancer

作　　者：蔡金来[1] 刘伟[1] 高峥[1] 杨燕[1] 沈卫[1] 徐美华[1] 潘芳芳[1] 

机构地区：[1]上海杨浦区中心医院核医学科,上海200090

出　　处：《诊断学理论与实践》2009年第2期185-187,共3页Journal of Diagnostics Concepts & Practice

摘　　要：目的:研究99mTc-MDP(亚甲基二膦酸盐)核素骨显像结合前列腺特异性抗原游离水平与总量比值(FPSA/TPSA)测定在诊断前列腺癌及其骨转移中的价值。方法:对经病理证实并行骨显像和FPSA、TPSA检查的147例前列腺癌患者的临床及检测资料进行回顾性分析。结果:147例前列腺癌患者中,核素骨显像提示102例出现骨转移(占69.4%),其骨转移病灶"热区"数共631个,其中显示≥3个病灶者为81例(79.4%),2个病灶的15例(14.7%),1个病灶的6例(5.9%)。经随访发现,骨转移累及部位以盆骨最多(96例,占94.1%),且最早;其次是脊柱(77例,占75.5%)和肋骨(54例,占52.9%)。发生骨转移患者术前的血清TPSA、FPSA、FPSA/TPSA(F/T)分别为(99.14±58.90)μg/L、(11.10±8.22)μg/L、0.10±0.05;无骨转移患者血清TPSA、FPSA、F/T则分别为(24.32±21.91)μg/L、(4.37±3.43)μg/L、0.18±0.04;2组间差异有统计学意义(P<0.01)。血清TPSA、FPSA浓度与骨转移率呈正相关。PSA<10μg/L时,患者骨转移率为2.6%;PSA为10～20μg/L,骨转移率为10.5%;PSA为21～50μg/L,骨转移率为52.6%;PSA为51～100μg/L,骨转移率为92.7%;PSA>100μg/L时,骨转移率达100%。结论:对疑为前列腺癌的患者,特别是年龄>50岁者,更应重视核素骨显像和血清TPSA、FPSA检查,并计算F/T比值,密切注意随访。Objective To study the importance of ^99mTc-MDP hone imaging combined with FPSA （free prostate specific antigen）/TPSA （total prostate specific antigen） ratio in the diagnosis of prostate cancer and its bone metastasis. Methods The clinical and laboratory data of 147 patients with prostate cancer confirmed by pathology and ^99mTc-MDP performed were retrospectively analyzed. Results Of the 147 patients, 102 cases （69.4%） were found to have bone metastasis with 331 ＂hot area＂ demonstrated by ^99mTc-MDP bone imaging. There were 77 cases （75.5%） had more than 3 ＂hot area＂, 15 cases （14.7%） had 2 ＂hot area＂,10 cases （9.8%） had l＂hot area＂. Pelvis was the most frequent and the earliest site （96 cases, 94.1%） of bone metastasis, then were the spinal column （77eases,75.5%） and the ribs （54 cases, 52.9%）. Serum TPSA, FPSA and FPSA/TPSA ratio in hone metastasis group were （99.14±58.90） μg/L, （11.10±8.22） μg/L, and 0.10±0.05, respectively. Those of non-bone metastasis group were （24.32±21.91） μg/L, （4.37±3.43） μg/L and 0.18±0.04, respectively. Serum FPSA and TPSA were positively correlated with the rate of bone metastasis. When PSA was less than 10 μg/L, the rate of bone metastasis was 2.6%; when PSA was from 10 μg/L to 20 μg/L, the rate of bone metastasis was 10.5%; when PSA was from 21 μg/L to 50 μg/L, the rate of bone metastasis was 52.6%; when PSA was from 51 μg/L to 100 μg/L, the rate of bone metastasis was 92.7%; and when PSA was high than 100 μg/L, the rate of bone metastasis was 100%. Conclusions Of those suspected to have prostate cancer （specially the men 〉50 years old） emphasis should he paid on radionuclide bone imaging and the measurement of FPSA and TPSA, and calculate the FPSA/FPSA ratio, and the patient should he followed cautiously. Early diagnosis and treatment are very important for the prognosis of patient.

关 键 词：锝放射性同位素 前列腺癌 前列腺特异抗原 骨转移 

分 类 号：R737.25[医药卫生—肿瘤]