吲哚菁绿联合近红外自体荧光在甲状旁腺病变识别中的应用初探  

Preliminary exploration of the application of indocyanine green combined with near-infrared autofluorescence in the identification of parathyroid lesions

作　　者：刘瑞鸣 李祖飞 钟琦[1] 张洋[1] 黄志刚[1] 黄俊伟[1] LIU Ruiming;LI Zufei;ZHONG Qi;ZHANG Yang;HUANG Zhigang;HUANG Junwei(Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Key Laboratory of Otolaryngology Head and Neck Surgery(Capital Medical University),Ministry of Education,Beijing,100730,China;Department of General Surgery,Sinopharm Tongmei General Hospital,Datong,Shanxi,037036,China)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京100730 [2]国药同煤总医院普通外科,山西大同037036

出　　处：《中国耳鼻咽喉头颈外科》2024年第9期545-548,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：国家自然科学基金项目(82071032、82072997、82271150)。

摘　　要：目的探索吲哚菁绿联合近红外自体荧光成像技术在原发性甲状旁腺功能亢进(primary hyperparathyroidism,PHPT)手术中识别病变甲状旁腺的应用价值。方法收集就诊于首都医科大学附属北京同仁医院的40例PHPT患者数据,所有患者均行手术治疗切除病变甲状旁腺。其中吲哚菁绿给药组10例,非给药组30例。采用近红外自体荧光成像仪进行图像采集,ImageJ软件进行荧光强度分析。结果吲哚菁绿给药组的病变甲状旁腺荧光强度显著高于非给药组(142.7±23.7 vs.94.5±31.4,t=-4.434,P=0.000);病变甲状旁腺/甲状腺荧光比值显著高于非给药组(1.6±0.3 vs.1.2±0.4,t=-3.162,P=0.004)。非给药组甲状旁腺荧光强度与术前血钙(r=0.029,P=0.088)及术前甲状旁腺激素(PTH)(r=-0.142,P=0.455)均无相关性,给药组甲状旁腺荧光强度与术前血钙(r=0.206,P=0.568)及术前PTH(r=0.160,P=0.658)均无相关性。非给药组近红外光检出率为53.3%(16/30),给药组近红外光检出率为100%(10/10)。非给药组的平均检出时间为(71.0±16.9)min,给药组的平均检出时间为(52.7±11.1)min,差异比较有统计学意义(t=3.187,P=0.003)。结论吲哚菁绿联合近红外自体荧光成像技术有助于在PHPT手术治疗中识别病变甲状旁腺。OBJECTIVE To explore the application value of indocyanine green combined with near-infrared autofluorescence imaging technique in identifying pathological parathyroid glands during surgery for primary hyperparathyroidism(PHPT).METHODS Data from 40 patients with PHPT treated in Beijing Tongren Hospital,Capital Medical University were collected,including 10 patients in the indocyanine green treated group and 30 patients in the non-treated group.All patients underwent surgical treatment to remove the affected parathyroid glands.Near-infrared autofluorescence imaging was used for image acquisition,and ImageJ software was used for fluorescence intensity analysis.RESULTS The fluorescence intensity of the pathological parathyroid glands in the indocyanine green-treated group was significantly higher than that in the non-treated group(142.7±23.7 vs.94.5±31.4,t=-4.434,P=0.000);the fluorescence ratio of pathological parathyroid glands/thyroid glands was significantly higher than that in the non-treated group(1.6±0.3 vs.1.2±0.4,t=-3.162,P=0.004).There was no correlation between the fluorescence intensity of parathyroid glands in the non-treated group and preoperative blood calcium(r=0.029,P=0.088)and preoperative PTH level(r=-0.142,P=0.455),and there was also no correlation between the fluorescence intensity of parathyroid glands in the treated group and preoperative blood calcium(r=0.206,P=0.568)and preoperative PTH level(r=0.160,P=0.658).The detection rate of near-infrared light in the non-treated group was 53.3%(16/30),while that in the treated group was 100%(10/10).The average detection time for the non-treated group was(71.0±16.9)minutes,while that for the treated group was(52.7±11.1)minutes,with a significant difference between the two groups(t=3.187,P=0.003).CONCLUSION The combination of indocyanine green and near-infrared autofluorescence imaging technique is helpful for identifying the diseased parathyroid glands during the surgical treatment of PHPT.

关 键 词：甲状旁腺功能亢进 原发性 甲状旁腺 近红外自体荧光 吲哚菁绿 

分 类 号：R653[医药卫生—外科学]