SPECT显像在转甲状腺素蛋白心脏淀粉样变中的应用  

SPECT scintigraphy in amyloid transthyretin cardiac amyloidosis

作　　者：张莹 崔静 ZHANG Ying;CUI Jing(Department of Nuclear Medicine,Henan Provincial People’s Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou University People’s Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]河南省人民医院,阜外华中心血管病医院,郑州大学人民医院核医学科,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2021年第10期991-994,共4页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：应用^(99)mTc标记的双膦酸盐进行骨显像是临床经典的SPECT检查项目。该类骨显像剂中的^(99)mTc-亚锡焦磷酸钠(^(99)mTc-PYP)、^(99)mTc-3、3-二羧丙烷-2、1-二膦酸盐(^(99)mTc-DPD)和^(99)mTc-羟基亚甲基二膦酸盐(^(99)mTc-HMDP)可定位于心脏淀粉样蛋白沉积物,具体机制尚未阐明。SPECT显像是一种较成熟的显像技术,对诊断转甲状腺素蛋白淀粉样变性(amyloid transthyretin,ATTR)型心脏淀粉样变(cardiac amyloidosis,CA)具有较高的灵敏度和特异度。SPECT显像具有较标准的操作程序和诊断标准,可早于超声心动图或心脏MRI识别ATTR型CA,已被纳入多部专家共识。目前SPECT显像诊断ATTR型CA依据Perugini视觉评分法和半定量分析法,尚无法做到绝对定量。显像剂的摄取程度与疾病严重程度和不良预后相关。SPECT显像能否作为CA疗效监测的方法有待进一步研究。Radionuclide bone scintigraphy with ^(99)mTc labeled bisphosphonates has been a classical SPECT examination. Three ^(99)mTc labeled bisphosphonate agents as ^(99)mTc labeled pyrophosphate, ^(99)mTc labeled 3,3-diphosphono-1, 2-propanodicarboxylic acid, and ^(99)mTc labeled hydroxymethylene diphosphonate, can target at the cardiac amyloid deposits, although the specific mechanism has not been clarified. SPECT has been a mature imaging technique, and has remarkably sensitivity and specificity to amyloid transthyretin-cardiac amyloidosis. With standard operating procedures and diagnostic criteria, SPECT imaging can distinguish amyloid transthyretin-cardiac amyloidosis earlier than echocardiography or cardiac MRI, and has been included in many consensuses of experts. The current diagnostic criteria contains visual and semi-quantification analysis, while fully radionuclide quantification has not been determined yet. The uptake of the tracers is correlated with the severity and prognosis of the disease, so whether SPECT can be used to monitor the efficacy on amyloid transthyretin needs further study.

关 键 词：转甲状腺素蛋白淀粉样变性 心脏淀粉样变 SPECT显像 

分 类 号：R541[医药卫生—心血管疾病]