尿酸、碱性磷酸酶联合骨显像检测在低磷骨软化症鉴别诊断中的价值  

Value of Uric Acid and Alkaline Phosphatase Combined with Bone Imaging in Differential Diagnosis of Hypophophatemic Oestemalacia

作　　者：曾令鹏 罗侃莹 张庆[1] 张青[1] ZENG Ling-peng;LUO Kan-ying;ZHANG Qing;ZHANG Qing(Department of Nuclear Medicine,the First Affiliated Hospital of Nanchang University;Department of Breast Surgery,Jiangxi Provincial People’s Hospital,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院核医学科 [2]江西省人民医院血管乳腺外科,南昌330006

出　　处：《南昌大学学报（医学版）》2022年第5期63-67,共5页Journal of Nanchang University：Medical Sciences

摘　　要：目的探讨低磷骨软化症骨显像的影像学特点,比较低磷骨软化症与多发骨转移恶性肿瘤患者年龄、性别、血钙、碱性磷酸酶(ALP)、尿酸等水平的差异。方法回顾性分析南昌大学第一附属医院2015年3月至2021年3月收治的21例低磷骨软化症(A组)与20例多发骨转移恶性肿瘤患者(B组)的临床资料,分析2组患者骨显像的影像学特点,比较2组患者的年龄、性别、血钙、ALP、尿酸等水平的差异。结果骨显像显示,A组以肋骨及四肢骨受累最常见,肋骨表现为散在点状核素浓聚,病灶大小、浓聚程度基本一致,股骨、膝关节、踝关节多表现为双侧对称性核素浓聚,也可表现为单侧浓聚;B组以脊椎、骨盆受累最为常见,主要表现为病灶分布无规律,大小及浓聚强度不一,可呈点状、条索状、团块状核素浓聚,肋骨病灶常沿着肋骨走形呈条索状核素浓聚。A组ALP水平、肌酐水平显著高于B组,而尿酸水平显著低于B组,差异均有统计学意义(P<0.05)。受试者工作特征(ROC)曲线分析显示尿酸、ALP最佳截断值分别为171.0μmol·L^(-1)、208.5 U·L^(-1),对应诊断低磷骨软化症敏感度分别为81.1%、86.0%,特异度分别为100.0%、85.0%。结论低磷骨软化症骨显像有一定的影像学特点,但有时仍与多发骨转移较难鉴别,结合患者病史及ALP、尿酸水平对两者的鉴别有一定的价值。Objective To investigate the imaging features of hypophophatemic osteomalacia,and to compare the age,gender,blood calcium,alkaline phosphatase(ALP)and uric acid between patients with hypophophatemic osteomalacia and those with multiple bone metastases.Methods The clinical data of 21 cases of hypophophatemic osteomalacia(group A)and 20 cases of multiple bone metastases(group B)admitted to the First Affiliated Hospital of Nanchang University from March 2015 to March 2021 were analyzed retrospectively.The characteristics of bone imaging were analyzed in both groups.The age,gender and levels of blood calcium,ALP and uric acid were compared between the two groups.Results Bone imaging revealed that hypophophatemic osteomalacia had the most common bone involvement in ribs and extremities.In group A,the ribs mainly displayed scattered punctate radionuclide concentration with basically the same size and concentration degree of lesions,and the femur,knee joint and ankle joint mostly showed bilateral symmetric radionuclide concentration or unilateral concentration.Group B were most involved in the spine and pelvis,bone imaging was mainly manifested by irregular distribution and various sizes and concentration degrees of lesions with spotted,stranded or lumpy,the rib lesions often showed rope-shaped radionuclide concentration along the ribs.Compared with group B,the levels of ALP and creatinine increased but the concentrations of uric acid decreased in group A(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the optimal cut-off values of uric acid and ALP were 171.0μmol·L^(-1) and 208.5 U·L^(-1),respectively.The sensitivity and specificity for the diagnosis of hypophophatemic osteomalacia were,respectively,81.1%and 100.0%for uric acid,and 86.0%and 85.0%for ALP.Conclusion Hypophophatemic osteomalacia has certain imaging characteristics,but sometimes it is difficult to differentiate from multiple bone metastases.The combination of medical history and ALP and uric acid levels has a certain value in th

关 键 词：低磷骨软化症 骨转移 放射性核素显像 尿酸 碱性磷酸酶 

分 类 号：R814.42[医药卫生—影像医学与核医学]