继发性甲状旁腺功能亢进患者甲状旁腺^(99)Tc^m-MIBI显像与钙磷代谢相关性研究  

Correlation between ^(99)Tc^m-MIBI imaging of parathyroid gland and calcium-phosphorus metabolism in patients with secondary hyperparathyroidism

作　　者：刘轶敏 刘宇 霍力 陈丽萌[2] 王正华 胡亚[3] 李雪梅[2] 景红丽 陈黎波[1] 廖泉[3] 李方 LIU Yi-min;LIU Yu;HUO Li

机构地区：[1]中国医学科学院北京协和医院核医学科医学转化中心,北京100730 [2]中国医学科学院北京协和医院肾内科,北京100730 [3]中国医学科学院北京协和医院基本外科,北京100730

出　　处：《中国医学装备》2018年第4期1-5,共5页China Medical Equipment

基　　金：国家自然科学基金(81571713)"肝细胞乙酸盐PET动态显像的动力学分析及临床应用研究";北京市科委培育基金(Z151100003915133)"~(11)C-Acetate和~(18)F-FDG PET/CT联合显像评估多发性骨髓瘤治疗疗效及预后";首都特色发展基金转化医学(2016-2-40115)"连续移动扫描PET成像技术的临床转化研究";中国医学科学院医学与健康科技创新工程重大协同创新项目(2016-I2M-4-003)"心肺血管病的分子影像诊断结合型干预治疗的研究"

摘　　要：目的:回顾性分析继发性甲状旁腺功能亢进(SHPT)患者甲状旁腺显像与血甲状旁腺激素(PTH)和钙磷代谢结果的关系。方法:选取125例临床确诊的SHPT患者,按常规方法行^(99)Tc^m-甲氧基异丁基异腈(^(99)Tc^m-MIBI)甲状旁腺双时相显像,采用视觉分析法统计阳性(高于周围组织)病例数、病灶数、病灶浓聚程度、病灶形态及病灶双期变化特点;收集显像前或显像后1个月内血PTH、钙和磷结果,采用IBM 22.0软件进行统计学分析。结果:72例^(99)Tc^m-MIBI显像阳性患者血PTH(999.1±943.1)pg/ml及血钙(2.5±0.3)mmol/L水平高于53例显像阴性患者(164.5±218.5)pg/ml,(2.4±0.2)mmol/L,血磷无差异。PTH>200 pg/ml患者中,^(99)Tc^m-MIBI显像阳性率为86.8%(46/53),PTH<100 pg/ml时,阳性率仅为19.5%(8/41)。61.1%(44/72)患者病灶位于一侧,4例病灶位于甲状腺外。单发血PTH及血磷(708.4±802.5)pg/ml和(1.1±0.6)mmol/L明显低于双发(1208.9±934.6)pg/ml和(1.8±0.8)mmol/L及多发组(1559.5±1060.1)pg/ml和(1.9±0.8)mmol/L,双发及多发组间血PTH无差异,三组间血钙无差异。病灶对^(99)Tc^m-MIBI浓聚程度、浓聚形态及双期变化形式与血PTH、钙和磷无关。结论:核医学甲状旁腺显像对PTH>200 pg/ml的SHPT患者病灶诊断能力强。双期显像中任一期出现阳性病灶即可诊断功能亢进的甲状旁腺组织,需分次手术切除所有阳性病灶方可缓解症状,核医学甲状旁腺显像有助于术前定位。Objective:To retrospectively analyze the correlation between 99Tcm-MIBI imaging of parathyroid gland and serum levels of parathyroid hormone(PTH),calcium-phosphorus metabolism in patients with secondary hyperparathyroidism(SHPT).Methods:125 patients with SHPT(50 males,75 females,49.8±14.4 years old)were enrolled in the study.And all of them underwent routine 99Tcm-MIBI dual time phase scan for parathyroid gland.Depending on visual analysis,the number of positive cases,amount of lesions,gathering degree of lesions,morphological feature of lesions and the characteristics of change of lesions at dual phases were counted.And serumlevels of parathyroid hormone(PTH)and the results of blood calcium and blood phosphorus at pre imaging or post imaging 1month were collected,and the IBM 22.0 software was applied to carry out statistical analysis.Results:The serum PTH(999.1±943.1)pg/ml and blood calcium(2.5±0.3)mmol/L of 72 patients with positive 99Tcm-MIBI imaging were higher than that of 53 patients with negative 99Tcm-MIBI imaging(164.5±218.5 pg/ml,2.4±0.2 mmol/L).And there was no difference between the two groups at blood phosphate.When PTH more than 200 pg/mL,the positive rate of 99Tcm-MIBI imaging was 86.8%(46/53),and it only was 19.5%(8/41)when PTH less than 100 pg/mL.And the lesions of 61.1%(44/72)patients located at one side,and 4 lesions were beside thyroid gland.And the PTH and blood phosphate of single lesion group(708.4±802.5 pg/mL,1.1±0.6 mmol/L)were obviously lower than that of dual lesions group(1208.9±934.6 pg/mL,1.8±0.8 mmol/L)and multi lesions group(1559.5±1060.1 pg/mL,1.9±0.8 mmol/L).And there was no difference between dual lesions group and multi lesions group at serum PTH,and there was no difference among three groups at blood calcium.Besides,gathering degree of lesions,morphological feature of lesions and change form of lesions at dual phases were not correlative with serum PTH,blood calcium and blood phosphate.Conclusion:The parathyroid gland imaging of nuclear medicine has strong diagnosti

关 键 词：继发性甲状旁腺功能亢进 99Tcm-甲氧基异丁基异腈(99Tcm-MIBI) 单光子发射计算机断层扫描(SPECT) 血甲状旁腺激素(PTH) 血钙磷 

分 类 号：R817.4[医药卫生—影像医学与核医学]