99mTc-MDP SPECT全身骨显像与生物标志物水平检测鉴别良恶性疾病的临床价值  

Clinical significance of 99mTc-MDP bone scintigraphy and biomarker determination in diagnosis of benign and malignant disease

作　　者：成浩[1] 冯纲[2] CHENG Hao;FENG Gang(Nuclear Medicine Department, the First People’s Hospital of Tiammen, Tianmen, Hubei 431700, China)

机构地区：[1]天门市第一人民医院核医学科,湖北天门431700 [2]天门市第一人民医院检验科,湖北天门431700

出　　处：《中国卫生检验杂志》2019年第10期1251-1253,1258,共4页Chinese Journal of Health Laboratory Technology

摘　　要：目的探讨99mTc-MDP全身骨显像的灵敏度、特异性和准确性,并与生物标志物检测鉴别良恶性疾病的临床价值。方法选恶性肿瘤患者135例(肺癌45例、前列腺癌36例和乳腺癌54例)进行了99mTc-MDPSPECT全身骨显像。本文测定135例恶性肿瘤、75例良性肿瘤患者及80例正常对照组的血清ALP、CA19-9、APOA1、APOB和D-D水平,并进行了对比研究。受试者工作曲线(receiver operating characteristic curve,ROCcurve)评估生物标志物水平预测恶性肿瘤向骨转移的临床价值。结果135例99mTc-MDP骨显像患者诊断脊柱转移瘤的灵敏度、特异性和准确性分别为54.81%、62.58%和63.79%。135例恶性肿瘤患者较之80例正常对照组血清ALP水平显著增高,CA19-9水平显著增高,APOA1水平降低,APOB水平明显增高,D-D水平显著增高。74例恶性肿瘤骨转移患者较之61例未骨转移患者血清ALP水平显著增高、CA19-9和APOB水平增高、APOA1水平降低和D-D水平显著增高。ROC曲线预测恶性肿瘤向骨转移时,在确定血清ALP和D-D的临界值为1.26U/L和1.16μg/ml,AUC分别为0.896和0.853,敏感度分别为86.32%和84.3%,特异度分别为92.34%和90.14%。结论99mTc-MDP全身骨显像与生物标志物水平联检具有鉴别良恶性疾病的临床意义,血清ALP和D-D水平是评估恶性肿瘤未骨转移向骨转移转化的有价值指标。Objective To explore the clinical value of 99mTc - MDP bone scintigraphy’s sensitivity, specificity and accurancy and combination determination of biomakers in the diagnosis of benign and malignant disease. Methods A total of 135 cases with malignant tumor ( 45 cases of lung cancer, 36 cases of prostate carcinoma and 54 cases of breast cancer) were selected and underwent 99mTc - MDP bone scintigraphy. The serum levers of ALP, CA199, APOA1, APOB and D - D in 135 patients with malignant tumor, 75 patients with benign tumor and 80 normal controls were determined. ROC curve was used to predict the clinical value of biomarkers in accessing malignant tumor bone no - metastases transferring to bone metastases. Results The sensitivity, specificity and accurancy of 99mTc - MDP bone scientigraphy in detecting bone metastases of spine were 54. 81%, 62. 58% and 63. 79% respectively. Compared with 80 controls, serum ALP level significantly increased in 135 cases with malignant tumors, CA199 level significantly increased, APOA1 level decreased, APOB levels significantly increased, and D - D levels significantly increased. Compared with 61 patients with non - bone metastasis, 74 patients with malignant tumor metastases had significantly higher serum ALP level, increased CA199 and APOB levels, decreased APOA1 levels, and significantly increased D - D levels. When ROC curve predicting bone metastasis of malignant tumor, the critical values of serum ALP and DD were 1. 26 U /L and 1. 16 μg /ml, AUCs were 0. 896 and 0. 853, respectively, and the sensitivity was 86. 32% and 84. 3%, respectively. The specificity was 92. 34% and 90. 14%, respectively. Conclusion The combined determination of 99mTc - MDP bone scintigraphy and biomarkers levels were of great significance in the diagnosis of benign and malignant diseases. The serum ALP and D - D levels are valuable index on accessing bone metastases from malignant tumor without bone metastases.

关 键 词：99mTc-MDP全身骨显像 恶性肿瘤 生物标志物 转移 有价值指标 

分 类 号：R683[医药卫生—骨科学]