99mTc-DTPA眼眶显像用于甲状腺相关眼病患者综合评价  

The value of 99mTc-DTPA orbital SPECT used in the comprehensive evaluation of patient with thyroid associated ophthalmopathy

作　　者：李方都 褚俏梅 张立颖 邵慧丽 朱诚 张金龙 蒋静 沈江帆 

机构地区：[1]普陀区利群医院核医学科,上海200333 [2]普陀区利群医院眼科,上海200333 [3]普陀区中心医院核医学科,上海200062

出　　处：《中国实用眼科杂志》2015年第9期1008-1012,共5页Chinese Journal of Practical Ophthalmology

基　　金：上海市普陀区卫生系统自主创新科研资助项目（普科委[2008]32号）

摘　　要：目的 采用99mTc-二亚乙基三胺五乙酸（99mTc-DTPA）眼眶显像、血清中可溶性细胞粘附分子-1（ICAM-1）、胰岛素样生长因子-1（IGF-1）的表达,对经131I治疗的甲亢伴有甲状腺相关眼病患者的眼眶活动性进行综合评价.方法 临床病例对照研究,对2010年1月至2014年6月在上海市普陀区利群医院核医学科就诊的88例Graves眼病（GO）患者依据临床活动度评分（CAS）标准,分为活动期组52例、静止期组36例,另设无眼病GD组34例,健康对照组26例.经99mTc-DTPA眼眶平面及断层显像方法获得的半定量指标——眼眶显像剂摄取率（UR）,以及测定血清ICAM-1、IGF-1水平被用以评价其与GO活动性的关系.结果 活动期组血清ICAM-1、IGF-1、眼眶UR明显高于其他组,其差异有统计学意义（P＜0.01）.且眼眶UR分别与患者血清ICAM-1、IGF-1成正相关,差异有统计学意义（r =0.519,P=0.001和r=0.528,P=0.001）.结论 99mTc-DTPA显像是一种判断GO患者活动性的指标,能够较为直观的评价眼眶的炎性活动.ICAM-1、IGF-1和99mTc-DTPA眼眶显像水平的变化分别反映GO的眶内增殖、自身免疫状态、炎性水肿的情况,作为综合度量分析方法对甲状腺相关眼病的评估有其较好临床价值。Objective To evaluate the intraorbital inflammatory activity of the patients with ophthalmopathic Graves＇ disease after 131I treatment using 99mTc-diethylene triamine pentaacetic acid （DT-PA） orbital SPECT, and the expression of serum intercellular adhesion molecule-1 （ICAM-1） and insulin-like growth factors-1 （IGF-1）.Methods Clinical case-control study, 88 Graves＇ ophthalmopathy （GO） patients visiting the nuclear medicine department of Liqun Hospital of Shanghai Putuo District from January 2010 to June 2014 were divided into 2 groups according to the clinical activity score （CAS）： active GO group （n =52） and resting GO group （n =36）, 34 no ophthalmopathy GD patients and 26 healthy subjects were served as control separately.Semi-quantitative calculation of the orbital DTPA uptake rate （UR） obtained by 99mTc-DTPA SPECT, and determination of the serum ICAM-1 and IGF-1 were assessed to monitor the activity of GO.Result the level of ICAM-1, IGF-1 and orbital UR in active GO group were significantly higher than that of all other groups （P 〈0.01）.The orbital UR had positive correlation with ICAM-1 （r =0.519, P =0.001）, as well as with IGF-1 （r =0.528, P =0.001）.Conclusions As a method to judge the activity of GO, 99mTc-DTPASPECT has the characters of intuitive and authentic.Reflecting the status of intraorbital hyperplasia, autoimmunity and inflammatory edema separately, the combination of ICAM-1, IGF-1 and 99mTc-DTPA Orbital SPECT may serve as a satisfactory clinical measurement of the thyroid associated ophthalmopathy.

关 键 词：99mTc-二亚乙基三胺五乙酸 体层摄影术 单光子 GRAVES眼病 眼眶 可溶性细胞粘附分子-1 胰岛素样生长因子-1 

分 类 号：R817.4[医药卫生—影像医学与核医学]