^(18)F-FDG PET/CT显像在噬血细胞性淋巴组织细胞增生症中的应用价值  

Value of ^(18)F-FDG PET/CT imaging in hemophagocytic lymphohistiocytosis

作　　者：党娜[1] 孙英 董有文 张谷青[1] 高明[1] Dang Na;Sun Ying;Dong Youwen;Zhang Guqing;Gao Ming(Department of Medical Imaging,Affiliated Hospital of Jining Medical University,Jining 272000,China;Department of Obstetrics and Gynecology,Affiliated Hospital of Jining Medical University,Jining 272000,China)

机构地区：[1]济宁医学院附属医院医学影像科,济宁272000 [2]济宁医学院附属医院妇产科,济宁272000

出　　处：《中华核医学与分子影像杂志》2024年第7期401-405,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨^(18)F-FDG PET/CT显像对噬血细胞性淋巴组织细胞增生症(HLH)的病因诊断能力。方法回顾性分析2017年1月至2023年1月于济宁医学院附属医院行^(18)F-FDG PET/CT显像的49例初诊HLH患者(男32例、女17例,年龄19~61岁)。观察并记录PET/CT显像结果及临床资料。以病理学检查及临床随访结果为标准,计算PET/CT、PET、CT显像对HLH病因的诊断效能;采用χ^(2)检验、两独立样本t检验、Mann-Whitney U检验比较血液系统肿瘤相关性HLH与非血液系统肿瘤相关性HLH间PET/CT显像特征及临床指标的差异;采用多因素logistic回归分析血液系统肿瘤继发HLH的预测因素;采用ROC曲线分析计算血液系统肿瘤患者淋巴结SUVmax、可溶性CD25(sCD25)预测继发HLH的AUC和最佳阈值。结果PET/CT、PET、CT在HLH病因诊断中的灵敏度、特异性、准确性、阳性预测值、阴性预测值分别为85.7%(30/35)、8/10、84.4%(38/45)、93.8%(30/32)、8/13;77.1%(27/35)、6/10、73.3%(33/45)、87.1%(27/31)、6/14;62.9%(22/35)、5/10、60.0%(27/45)、81.5%(22/27)、5/18。不同病因组间淋巴结分布及边界、肝脾及骨骼病变特征、淋巴结及肝、脾、骨骼SUVmax、性别、年龄、WBC、中性粒细胞(ANC)、PLT、乳酸脱氢酶(LDH)、总胆红素(TBIL)、C反应蛋白(CRP)、sCD25差异均有统计学意义(χ^(2)值:3.91~9.66,t值:3.75~7.90,z值:3.82~4.01,均P<0.05)。淋巴结SUVmax、sCD25为血液系统肿瘤继发HLH的预测因素[比值比(OR):1.28(95%CI:1.09~1.72)、1.56(95%CI:1.17~2.49),P值:0.004、0.013];预测最佳阈值分别为12.6、40028 ng/L,AUC分别为0.87、0.76,灵敏度和特异性分别为88.6%(31/35)和8/10、65.7%(23/35)和7/10;两者结合后AUC为0.83,灵敏度和特异性分别为74.3%(26/35)和9/10。结论^(18)F-FDG PET/CT显像对HLH病因诊断具有较高价值;淋巴结SUVmax、sCD25为血液系统肿瘤继发HLH的预测因素。Objective To explore the diagnostic value of ^(18)F-FDG PET/CT imaging in etiology of patients with hemophagocytic lymphohistiocytosis(HLH).Methods Retrospective analysis was performed on 49 patients newly diagnosed as HLH(32 males,17 females;age 19-61 years)who received ^(18)F-FDG PET/CT imaging in Affiliated Hospital of Jining Medical University from January 2017 to January 2023.PET/CT images and clinical parameters were observed and recorded.Based on the pathological examination and clinical follow-up results,diagnostic efficacies for HLH etiology of PET/CT,PET and CT imaging were calculated.χ^(2) test,independent-sample t test and Mann-Whitney U test were used to compare the differences between hematologic tumors associated HLH and non-hematologic tumor associated HLH.Multivariate logistic regression was used to analyze the predictors of secondary HLH in hematologic tumors.ROC curve analysis was used to calculate AUCs and optimal threshold of lymph node SUVmax and soluble CD25(sCD25)to predict secondary HLH in patients with hematologic tumors.Results The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of PET/CT,PET and CT in the etiological diagnosis of HLH were 85.7%(30/35),8/10,84.4%(38/45),93.8%(30/32),8/13;77.1%(27/35),6/10,73.3%(33/45),87.1%(27/31),6/14;62.9%(22/35),5/10,60.0%(27/45),81.5%(22/27),5/18,respectively.There were differences in lymph node distribution and boundary,liver and spleen and bone lesions,SUVmax of lymph node and liver and spleen and bone,gender,age,WBC,neutrophil(ANC),PLT,lactate dehydrogenase(LDH),total bilirubin(TBIL),C-reactive protein(CRP)and sCD25 between different etiology groups(χ^(2) values:3.91-9.66,t values:3.75-7.90,z values:3.82-4.01,all P<0.05).SUVmax of lymph nodes and sCD25 were predictive factors for secondary HLH of hematological tumors(odds ratio(OR):1.28(95%CI:1.09-1.72),1.56(95%CI:1.17-2.49),P values:0.004,0.013).The optimal thresholds were 12.6 and 40028 ng/L,with the AUC of 0.87 and 0.76,with the sensitivity and specif

关 键 词：淋巴组织细胞增多症 嗜血细胞性 正电子发射断层显像术 体层摄影术 X线计算机 氟脱氧葡萄糖F18 

分 类 号：R733.1[医药卫生—肿瘤] R730.44[医药卫生—临床医学]