99Tcm-环丙沙星显像检测重症急性胰腺炎继发感染的实验研究  

99Tcm-ciprofloxacin imaging in detecting the secondary infection of severe acute pancreatitis

作　　者：汪建华[1] 邵成伟[2] 左长京[1] 郑建明[3] 潘桂霞[1] 彭烨[1] 崔斌[1] 张峰[2] 孙高峰[2] 

机构地区：[1]第二军医大学长海医院核医学科,上海200433 [2]第二军医大学长海医院影像医学科,上海200433 [3]第二军医大学长海医院病理科,上海200433

出　　处：《中华核医学杂志》2010年第3期201-205,共5页Chinese Journal of Nuclear Medicine

基　　金：基金项目：国家自然科学基金（30570535）;上海市教育委员会曙光计划项目（06SC,41）;上海市卫生局科研项目（2007JG0069）;“上海市医学领军人才培养计划”（LJ06006）

摘　　要：目的 用99Tcm标记环丙沙星,评估其生物学特性,并与病理学对照,探讨其在SPECT显像诊断重症急性胰腺炎（SAP）继发感染的价值.方法 制备99Tcm-环丙沙星,测定其标记率和放化纯,并研究其在正常幼猪体内的分布规律.分正常对照组（6头健康幼猪）、非感染组（6头未继发感染的SAP模型幼猪）和感染组（16头SAP继发感染的幼猪）.每头幼猪注射370～400 MBq 99Tcm环丙沙星,分别在给药后0.5,1,2,3,4和6 h行SPECT显像,观察比较不同组别放射性摄取,观察病灶放射性/本底比值随时间变化的规律.并将影像学诊断结果与病理结果对照,评价99Tcm-环丙沙星显像检出SAP继发感染的灵敏度和特异性.组内各时间点变化总体比较采用单因素重复测量的方差分析,组间两两比较及组内各时间点的病灶/本底比值两两比较采用最小显著差异法检验.结果 99Tcm-环丙沙星在6 h内标记率和放化纯均＞90%.静脉注射后药物主要分布在血供丰富的器官,如肾、肝、脾中.胃肠道内无明显摄取,血液清除快,主要经泌尿系统排泄.正常对照组和非感染组胰腺区在6 h内各时段摄取99Tcm-环丙沙星均不明显.感染组在注药后1 h胰腺感染灶开始显影,3 h达高峰,此时感染灶放射性/本底比值为3.36±0.33,明显高于其他时间点,经最小显著差异法检验,F=99.570,P＜0.001,差异有统计学意义.与病理结果对照,99Tcm-环丙沙星显像检测感染灶的灵敏度、特异性、阳性预测值和阴性预测值分别为88.2%（15/17）,5/6,93.8%（15/16）,5/7,约登指数为0.715,Kappa值0.667.结论 99Tcm-环丙沙星放射性分布特点适合胰腺感染灶显像.给药后3 h,SAP继发感染灶摄取明显,为最佳显像时间.用其检测SAP继发感染灶的灵敏度和特异性高,可作为诊断SAP继发感染的手段.Objective To evaluate the characteristics of 99Tcm-ciprofloxacin and explore its feasibility in early detection of secondary infectious foci of severe acute pancreatitis （SAP）.Methods Ciprofloxacin was labeled with 99Tcm.The labeling efficiency and radiochemical purity of 99Tcm-ciprofloxacin were calculated and its biodistribution in normal pigs was measured.The recruited baby pigs were divided into three groups：normal control group （6）, non-infected group （6） and infected group （16）.370-400 MBq of 99Tcm-ciprofloxacin was injected into each pig intravenously.SPECT scanning was performed at 0.5, 1,2, 3, 4 and 6 h after administration.The differences of 99Tcm-ciprofloxacin uptake among groups were calculated and the tracer activity ratio of lesion-to-background was recorded at each time point.The diagnostic value of 99Tcm-ciprofloxacin SPECT imaging for the dectection of secondary infection of SAP was assessed using histopathological results as the gold standard.Variance analysis and least significant difference test were used to analyze the data.Results Both the labehing efficiency and radiochemical purity of 99Tcm-ciprofloxacin were over 90% within 6 h.Organs with rich blood supply, such as kidney, liver and spleen were the target organs for the accumulation of 99Tcm-ciprofloxacin while no significant uptake was found in gastrointestinal tract or normal pancreas tissue of SAP.Rapid plasma clearance and renal excretion were observed.In the infected group, the lesion was visualized at 1 h after administration.The highest radioactivity ratio of lesion-to-background （3.36 ± 0.33） was at 3 h after administration, which was significantly higher than that of the other time point （ F =99.570, P 〈0.001 ）.The sensitivity, specificity, positive and negative predictive values, Youden＇s index （YI） and Kappa value of 99Tc%ciprofloxacin imaging were 88.2% （15/17）, 83.3% （5/6）, 93.8% （ 15/16）, 71.4% （5/7）, 0.715 and 0.667 respectively.Conclusions The biodistribution of99Tcm-cip

关 键 词：胰腺炎 感染 放射性核素显像 环丙沙星 猪 

分 类 号：R657.51[医药卫生—外科学]