新疆维族肺血栓栓塞症患者的PS-K196E多态性探讨

目的探讨蛋白S基因1(protein S1,PROS1)赖氨酸196谷氨酸的(PS-Lys196 Glu即PS-K196E,单字母命名法K-Lys,E-Glu)多态性与新疆地区维族人群肺血栓栓塞症(pulmonary thromboembolism,PTE)发生的相关性。方法采用病例—对照研究,病例组为经放射性肺通气/灌注显像和(或)螺旋CT肺动脉造影检查,并结合临床资料确诊的PTE患者100例,对照组为来自同一地区,性别、年龄匹配的健康对照100例。用酶联免疫吸附试验法测定PS活性(PS:A)。Massarray技术平台进行芯片点制及质谱检测PS-K196E的多态性。结果 PTE组和对照组的PS抗原活性分别是53.84%和90.50%,K196E突变杂合子携带者的PS活性降低到70.29%,纯合子携带者的PS活性降低到49.85%,差异具有统计学意义;病例组和对照组AG基因型的频率分别是55%和40%,对照组GG基因型的频率是35%和22%,差异有统计学意义(χ2=17.666,P0.05);AG和GG基因型与AA基因型的比值比分别是0.191和0.161(OR=0.191,95%CI 0.085～0.429;OR=0.165,95%CI 0.069～0.398);病例组和对照组的等位基因是G频率的62.5%和42%,差异有统计学意义(χ2=16.844,P0.05)。结论 PS-K196E突变的杂合子和纯合子的蛋白S的活性均降低,尤其是后者更明显,PS-K196E多态性与新疆地区维族人肺栓塞的发生可能有关。     

心钠素基因T2238C多态性和C型受体基因A-55C多态性与老年高血压病的关系

目的探讨心钠素（ANP）基因T2238C多态性及其C型受体（NPRC）基因A-55C多态性与老年高血压病的关系。方法采用基因芯片技术测定高血压病患者（238例）和健康对照者（184例）的ANP基因T2238C、NPRC基因A-55C多态性,并对两组检测结果进行基因型和等位基因频率的对照观察,应用logistic回归分析基因多态性对血压的影响。结果ANP基因T2238C基因型及等位基因频率在高血压病组与对照组比较差异均有统计学意义（χ^2=4．240～4．728,P均〈0．05）;两组间NPRC基因A-55C基因型和等位基因频率比较差异也有统计学意义（χ^2=5．517～5．950,P均〈0．05）。logistic回归分析显示ANP基因T2238C、NPRC基因A-55C是高血压病发病的危险因素（P〈0．05）。结论ANP基因T2238C和NPRC基因A-55C可能是高血压病的遗传易感基因。     

TM及TFPI的基因多态性与肺血栓栓塞症的相关性研究

目的：了解中国北方地区汉族人群血栓调节蛋白(TM)G-127A 及组织因子途径抑制物(TFPI)T-287C的基因多态性分布频率,探讨二者与肺血栓栓塞症(PTE)的发病关系。方法应用PCR-限制性片段长度多态性分析方法,对中国北方地区汉族人群80例确诊为PTE的患者和来自同一地方、性别、年龄相匹配的80名健康体检者的TM基因G-127A及TFPI基因T-287C 2个位点的多态性进行分析。结果中国北方地区汉族人群的 TM G-127A 位点及 TFPI T-287C 位点的基因型及等位基因频率分布符合 Hardy-Weinberg遗传平衡定律。PTE患者及健康对照者TM G-127A位点仅有1种基因型,为 GG基因型。PTE患者TFPI T-287C位点具有3种基因型,分别为 TT、TC、CC,其中TC基因型最多见,CC基因型最少见;健康对照者TFPI有3种基因型,分别为 TT、TC、CC,其中TT基因型最多见,CC基因型最少见。TFPI T-287C基因型TT、TC、CC在PTE组中的频率分别为35.0%、43.8%、21.3%,在健康对照组中的频率分别为55.0%、37.5%、7.5%。PTE 突变基因型(CC+TC)频率为65.1%(OR =2.270,95%CI ：1.201~4.290),突变等位基因(C)频率为43.1%(OR =2.130,95%CI ：1.330~3.412),均显著高于健康对照组(分别为45.0%、26.3%, P值均<0.05)。结论中国北方地区汉族人群中TM基因G-127A位点的突变较少见,可能不是PTE的危险因素;TFPI T-287C存在基因多态性,TFPI T-287C基因多态性可能与中国北方地区汉族人群发生PTE相关。     

IL-6R基因单核苷酸多态性与肺结核易感性的相关性研究

目的探讨白细胞介素-6受体（Interleukin-6R,IL-6R）基因多态性与汉族人群肺结核发病的关系。方法分析深圳汉族人群中96例结核病患者和96名健康对照的IL-6R基因rs1552481、rs4379670、rs3887104、rs2229238位点的多态性,分析基因多态性与结核病易感性的关系。结果 IL-6R基因rs4379670位点,病例组TA基因型频率（25.3）明显低于对照组（39.8）（P〈0.05）,病例组T等位基因频率（14.7）明显低于对照组（24.2）（P〈0.05）;rs2229238位点,对照组TC基因型频率（25.3）明显低于病例组（37.9）（P〈0.05）,病例组T等位基因频率（14.7）也明显低于对照组（24.2）（P〈0.05）;其他两个位点病例组和对照组之间无明显差异。结论 IL-6R基因rs4379670位点AA型和rs2229238位点CC型可能与肺结核发病相关,两位点中等位基因T可能为保护性基因。     

UCP3及SUR1基因多态性与我国北方地区汉族人群肥胖及相关表型的关系

目的采用病例-对照研究,探讨解偶联蛋白3（UCP3）Tyr210Tyr（C→T）和磺脲类受体1[ABCC8（SUR1）]Ser1370Ala（T→G）单核苷酸多态性（SNP）与肥胖及血清脂质、FPG等肥胖相关数量表型的关系。方法选取我国北方地区汉族人群中超重及肥胖患者（BMI≥25．O）300例;另入选300例年龄、性别匹配的正常体重者（18．5≤BMI〈25．0）为对照组。测定血浆脂质和FPG等肥胖相关数量表型;并采用实时荧光定量PCR技术,检测UCP3Tyr210Tyr（C→T）和SUR1Ser1370Ala（T→G）多态性基因型。结果（1）UCP3Tyr210Tyr（C→T）多态性基因型和等位基因频率在病例组和对照组分布无显著差异且与肥胖及其相关表型无关。（2）SUR1Ser1370Ala（T→G）的C／C、C／T和T／T基因型及等位基因频率在女性的病例组与对照组存在差异（P〈0．05）,而在男性组却无统计学差异;在病例组和对照组中的分布存在差异（P〈0．05）,病例组TT基因型及等位基因频率高于对照组;而仅按性别分层后也未发现基因型在两组间存在差异。由单变量及多变量逐步条件logistic回归分析皆显示SUR1基因Ser1370Ala（T→G）多态性与肥胖相关（P〈0．05）。发现TG和GG基因型频率越高则发生肥胖的可能性越小,TT基因型则相反是肥胖发生的危险因素（ORTG=0．549;ORGG=0．486）。多元线性回归分析发现：各基因型之间的生化指标除LDL—C（P〈0．05）外,其余各指标无统计学差异。按病例对照分层,肥胖组的各基因型之间TG、LDL-C和Glu均值水平存在差异（P〈0．05）,而TC、HDL—C水平的差异无统计学意义。体重正常组各基因型之间TG、LDL-C和Glu、TC、HDL—C平均值水平的差异无统计学意义。按性别进行分层后,发现除男性各基因型的DBP、TG、LDL-C水平存在差异（P〈0．05）,女性各基因型的TG、TC、LDL—C水平和BMI均值存在差异（P〈0．05）?     

MTHFR基因多态性与冠心病的关系

目的研究天津地区人群N^5,N^10-亚甲基四氢叶酸还原酶（MTHFR）基因C677T多态性与冠心病的关系。方法应用聚合酶链反应（PCR）技术和限制性酶切片段长度多态性（RFLP）分析技术检测50例冠心病患者（冠心病组）和50例正常人（对照组）的MTHFR基因C677T多态性,应用高效液相色谱法测定血浆同型半胱氨酸（Hcy）水平,采用125I标记放免法测定血清叶酸浓度。结果1.冠心病组与对照组MTHFR基因频率分布不同（P〈0.05）,对照组CC型、TC型、TT型基因频率分别为52.0%,28.0%,20.0%,冠心病组分别为26.0%,44.0%,30.0%。冠心病组T等位基因频率为52.0%,C等位基因频率为48.0%,与对照组比较有显著性差异（P〈0.05）。2.两组的TT基因型者血浆Hcy浓度均明显高于CC和TC基因型者（P〈0.05）,而后两者间无显著性差异（P〉0.05）。3.冠心病组Hcy浓度高于照组（P〈0.05）,两组叶酸水平无显著性差异（P〉0.05）,血浆Hcy浓度与叶酸水平呈显著负相关（r分别为-0.617和-0.588,P〈0.05）。结论MTHFR基因C677T点突变与冠心病发病密切相关,MTHFR基因纯合突变是引起高Hcy血症的一个重要的遗传因素。     

甘肃人群NQO1基因多态性与急性髓系白血病易感性的关系

目的：研究醌氧化还原酶（NQO1）基因多态性和急性髓系白血病易感性的关系。方法：用1：1配对病例-对照方法,PCR-LDR方法,对78例急性髓系白血病患者（AML）和100例对照人群进行NQO1基因突变分析。结果：AML病例组NQO1基因T等位基因频率（43%）和TC/TT基因型频率（63%）均高于对照组（28%和43%）。携带TC/TT基因型的个体发生AML的相对风险度为其野生型（CC）的1.67倍（95%CI=1.212～2.727）。结论：NQO1基因多态性与AML遗传易感性相关,等位基因C对AML易感性有保护作用。     

新疆维吾尔族老年人群延迟整流型钾离子通道KCNE1（G38S）基因多态性与心房颤动的相关性研究

目的探讨新疆维吾尔族老年人群延迟整流型钾离子通道KCNE1（G38S）基因多态性与心房颤动（AF）的相关性。方法收集新疆地区维吾尔族AF人群（AF组）和非AF人群（对照组）各70例的外周血样标本,提取DNA,采用等位基因聚合酶链反应（PCR-RFLP）的方法鉴定KCNE1（G38S）的基因型及等位基因分布。采用Logistic回归分析各种因素与房颤的相关性。结果 KCNE1基因G38S位点AA、AG、GG基因型频率在AF组分别为17.14%、27.14%、55.71%。在对照组分别为24.29%、50%、25.71%。2组基因型分布差异具有统计学意义（P〈0.05）,且AF组G等位基因频率明显高于对照组（P〈0.05）。Logistic回归分析结果显示KCNE1（G38S）GG基因型与维吾尔族人群AF的发生相关（P〈0.05）。结论新疆地区维吾尔族人群AF的发生与KCNE1（G38S）基因多态性相关。G38S位点多态性可能是维吾尔族AF患者的独立危险因素之一。     

抗凝血酶基因Ala384Ser多态性与肺血栓栓塞症相关性研究

目的 探讨抗凝血酶基因Ala384Ser多态性与肺血栓栓塞症(pulmonary thromboembolism,PTE)的相关性.方法 采用病例对照研究的方法,运用聚合酶链反应扩增,产物纯化.Pvu Ⅱ限制性内切酶片段长度多态性聚合酶链反应及DNA测序技术对65例PTE患者及65名健康对照者进行抗凝血酶基因Ala384Ser分析.结果 PTE组仅3.3%患者有PTE家族史,这与西方人群报道结果存在显著差别;心血管疾病家族史、口服避孕药、吸烟、饮酒史、外伤及手术史PTE组与对照组比较差异无统计学意义.PTE组、对照组等位基因频率为1、0,符合Hardy-Weinberg平衡定律,G/G、G/T、T/T基因型频率和G、T等位基因频率在PTE组与对照组之间差异无统计学意义.结论 抗凝血酶基因Ala384Ser多态性可能不是中国人群PTE的一个危险因素,与西方调查者实验结果的差别说明基因多态性存在种族差异,且在不同种族中PTE的致病机制可能不同.     

MBL基因多态性与新疆汉族人群结核病易感性的研究

目的探讨MBL基因多态性与新疆汉族人群结核病高发的关系。方法采用病例-对照研究方法和引物序列特异性PCR扩增（PCR-SSP）技术对新疆地区的231例肺结核患者和226例健康志愿者的MBL基因H/L、P/Q和A/B 3个多态性位点进行基因及单倍体分型,比较各等位基因及单倍体型的频率（f）,并计算优势比（OR）。结果对照组MBL基因AA基因型频率显著高于肺结核病例组（χ2=4.576,OR=0.613,P〈0.05）;而肺结核病例组MBL基因AB基因型频率显著高于健康对照组（χ2=4.821,OR=1.673,P〈0.05）。结论 MBL基因AA基因型与新疆汉族人群结核病负相关,其可能为当地汉族人群结核病的抵抗基因;而MBL基因AB基因型与新疆汉族人群结核病相关,其可能是当地汉族人群结核病的易感基因。     

Results of 188 whole-body fluorodeoxyglucose positron emission tomography scans in 137 patients with sarcoidosis

BACKGROUND: To study the role of whole-body 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) scans in the identification of occult biopsy sites and reversible granulomatous disease in patients with sarcoidosis. METHODS: A retrospective review was undertaken of 188 FDG PET scans performed in 137 patients with proven sarcoidosis. All patients had given a complete medical history and undergone a physical examination, standard chest radiograph, spirometry, diffusing capacity determination, and measurement of serum angiotensin-converting enzymes levels. RESULTS: One hundred thirty-nine whole-body scans had positive findings. The most common positive sites were mediastinal lymph nodes (54 scans), extrathoracic lymph nodes (30 scans), and lung (24 scans). The standardized uptake value (SUV) ranged from 2.0 to 15.8. Twenty occult disease sites were identified. Eleven repeat scans exhibited decreased SUV with corticosteroid therapy. The positive pulmonary FDG PET scan findings occurred in two thirds of patients with radiographic stage II and III sarcoidosis. Negative pulmonary FDG PET scan findings were common in patients with radiographic stage 0, I, and IV sarcoidosis. CONCLUSIONS: Whole-body FDG PET scans are of value in identifying occult and reversible granulomas in patients with sarcoidosis. However, a positive FDG PET scan finding, by itself, is not an indication for treatment.     

Use of integrated FDG PET/CT imaging in pulmonary carcinoid tumours

BACKGROUND: Integrated positron emission tomography (PET)/computed tomography (CT) scanners have been recently introduced in the diagnostic work-up of suspected pulmonary malignancy and demonstrate encouraging results in the staging of nonsmall-cell lung cancer. OBJECTIVE: To evaluate the usefulness of integrated FDG PET/CT in pulmonary carcinoid tumours. SETTING: University hospital. METHODS: We studied 13 patients (mean age +/- 1 SD, 57 +/- 11 years) with pulmonary carcinoid tumours. All patients demonstrated a single pulmonary lesion. Integrated PET/CT scan and surgical resection were performed in all patients. RESULTS: The pulmonary lesion size ranged from 1.1 to 5.0 cm. Final histological diagnosis confirmed 12 typical and one atypical pulmonary carcinoid. Mean proliferation rate of the typical carcinoids was 1.7 +/- 1.4%. None of the patients had recurrent carcinoid disease or died during follow-up (864 +/- 218 days). Mean standardized uptake value (SUV) of (18)F-fluorodeoxyglucose (FDG) in typical carcinoids was 3.0 +/- 1.5 (range 1.2 - 6.6); SUV in the atypical carcinoid was remarkably high with a value of 8.5. The SUV was lower than 2.5 in 6 of 12 patients (50%). Mediastinal lymph node metastases or extrathoracic metastases were not detected in any patient. CONCLUSIONS: (18)F-fluorodeoxyglucose PET/CT imaging improves accurate localization of metabolic activity and thus the interpretation of pulmonary lesions on CT. FDG uptake in pulmonary carcinoid tumours is often lower than expected for malignant tumours. Therefore, surgical resection or biopsy of lesions suspected to be carcinoids should be mandatory, even if they show no hypermetabolism on FDG PET images.     

Prevalence of occult metastatic disease in patients undergoing 18F-FDG PET for primary diagnosis or staging of lung carcinoma and solitary pulmonary nodules

Background: Accurate staging of lung cancer is essential in determining the most appropriate management plan, as detection of occult metastasis can significantly alter management. Aims: The aims of this study are to determine the prevalence of occult metastasis in patients undergoing 2‐¹⁸F‐fluoro‐2‐deoxy‐D ‐glucose (¹⁸F‐FDG) positron emission tomography (PET) for evaluation of suspected/proven lung carcinoma and correlate pre‐PET TNM stage with prevalence of metastasis. Methods: FDG‐PET, which identified patients with metastasis on institutional database, was re‐evaluated by a nuclear medicine physician blinded to clinical information. The confidence level of metastasis was scored on a 5‐point scale, with a score of ≥4 considered positive. Results: There were 67 of 645 (10%) patients identified with suspected occult metastasis on FDG‐PET. Twelve patients scoring ≤3 were excluded. Prevalence of occult metastasis was 10/156 (6%) in solitary pulmonary nodules (SPN); 22/319 (7%) and 23/170 (14%) in proven and suspected lung cancer, respectively. Positive predictive value of FDG‐PET for metastasis was 8/10 (80%) in solitary pulmonary nodules, 14/20 (70%) and 17/21 (81%) in proven and suspected lung cancer, respectively. ¹⁸F‐FDG‐avid lesions classified as false positives were patients with cholelithiasis, rib fractures and those with equivocal/negative bone scans or computed tomography on follow up. There was a higher incidence of true positive occult metastasis in patients in all stages of disease, particularly stage III disease. Conclusion: ¹⁸F‐FDG PET is predictive for occult metastatic disease in patients with solitary pulmonary nodules and proven or suspected lung cancer and is more likely to be present in all stages, particularly in stage III. PET findings should be actively pursued with correlative investigation to identify benign pathology in patients who remain candidates for curative treatment.     

Clinical prediction model to characterize pulmonary nodules: validation and added value of 18F-fluorodeoxyglucose positron emission tomography

BACKGROUND: The added value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) scanning as a function of pretest risk assessment in indeterminate pulmonary nodules is still unclear. OBJECTIVE: To obtain an external validation of the prediction model according to Swensen and colleagues, and to quantify the potential added value of FDG-PET scanning as a function of its operating characteristics in relation to this prediction model, in a population of patients with radiologically indeterminate pulmonary nodules. DESIGN, SETTING, AND PATIENTS: Between August 1997 and March 2001, all patients with an indeterminate solitary pulmonary nodule who had been referred for FDG-PET scanning were retrospectively identified from the database of the PET center at the VU University Medical Center. RESULTS: One hundred six patients were eligible for the study, and 61 patients (57%) proved to have malignant nodules. The goodness-of-fit statistic for the model (according to Swensen) indicated that the observed proportion of malignancies did not differ from the predicted proportion (p = 0.46). PET scan results, which were classified using the 4-point intensity scale reading, yielded an area under the evaluated receiver operating characteristic curve of 0.88 (95% confidence interval [CI], 0.77 to 0.91). The estimated difference of 0.095 (95% CI, -0.003 to 0.193) between the PET scan results classified using the 4-point intensity scale reading and the area under the curve (AUC) from the Swensen prediction was not significant (p = 0.058). The PET scan results, when added to the predicted probability calculated by the Swensen model, improves the AUC by 13.6% (95% CI, 6 to 21; p = 0.0003). CONCLUSION: The clinical prediction model of Swensen et al was proven to have external validity. However, especially in the lower range of its estimates, the model may underestimate the actual probability of malignancy. The combination of visually read FDG-PET scans and pretest factors appears to yield the best accuracy.     

河南省安阳市耐药肺结核病人治疗转归分析

目的为了解安阳市耐药肺结核病人治疗转归现况,为今后耐药病人的管理与治疗提供参考依据。方法将安阳市结核病防治所1994年6月至2004年6月10年间登记的耐药肺结核病人病历资料收集统计,进行回顾性总结分析。结果10年登记耐药肺结核病人221例,其中,初始耐药115例,获得性耐药106例;耐1药87例,耐2药57例,耐3药以上77例;MDR-PTB 60例;全程管理177例,自服药44例;标化治疗122例,个体化治疗99例;规则服药完成疗程165例,丢失56例。221例耐药肺结核病人1年转归总治愈率52.5%,丢失率25.3%。初始耐药病人治愈率67.0%,其中标化治疗耐1药病人治愈率88.1%;获得性耐药病人治愈率36.8%,其中标化治疗耐1药病人治愈率37.5%;MDR-PTB病人治愈率30.0%;规则服药完成疗程病人治愈率70.3%。结论短程标准化疗方案治疗初始耐药病人,特别是耐1药病人有较高的疗效,治疗获得性耐药病人及MDR病人效果较差。丢失率偏高是影响疗效的重要因素。建议对耐药病人实行专项登记,专项考核,强化管理措施,努力降低丢失率,减少难治性肺结核的发生。     

Role of bone marrow biopsy in staging of patients with classical Hodgkin’s lymphoma undergoing positron emission tomography/computed tomography

Several studies suggested that staging bone marrow biopsy (BMB) could be omitted in patients with classical Hodgkin’s lymphoma (cHL) when a positron emission tomography/computed tomography (PET/CT) is performed at baseline.To address the concordance between BMB and PET/CT in the detection of bone marrow involvement (BMI) and the BMB role in determining the Ann Arbor stage, we retrospectively collected data on 1244 consecutive patients with cHL diagnosed from January 2007 to December 2013. One thousand eighty-five patients who had undergone both BMB and PET/CT were analyzed, comparing the Ann Arbor stage assessed with PET/CT only to that resulting from PET/CT combined with BMB.One hundred sixty-nine patients (16%) showed at least one focal skeletal lesion (FSL) at PET/CT evaluation. Only 55 patients had a positive BMB (5.1%); 34 of them presented at least one FSL at PET/CT. To the contrary, 895 out of 1030 patients with a negative BMB did not show any FSL (86.9%). Positive and negative predictive values of PET/CT for BMI were 20 and 98%, respectively; sensitivity and specificity were 62 and 87%, respectively. Fifty-four out of 55 patients with a positive BMB could have been evaluated as an advanced stage just after PET/CT; only one patient (0.1%) would have been differently treated without BMB.Our data showed a very high negative predictive value of PET/CT for BMI and a negligible influence of BMB on treatment planning, strengthening the recent indications that BMB could be safely omitted in cHL patients staged with PET/CT.     

Staging by positron emission tomography predicts survival in patients with non-small cell lung cancer

BACKGROUND: Positron emission tomography (PET) scanning is used increasingly to detect and stage lung cancer, but the test performance characteristics and relationship of PET to patient outcomes remain undefined. OBJECTIVE: To determine the test performance characteristics and relationship of PET scanning stage to patient outcomes relative to the 1997 International System for the Staging of Lung Cancer. DESIGN: Survival analysis using pathologic staging as the criterion standard for comparison of survival as predicted by staging by PET and CT. SETTING: University-based hospital. PATIENTS: All consecutive patients undergoing PET scanning for the evaluation of possible non-small cell lung cancer (NSCLC) during a 5-year period. Main outcome measures: Long-term survival of patients with NSCLC after staging by PET. RESULTS: One hundred fifty-two thoracic PET scans were obtained for the staging of possible NSCLC during a 5-year period. One hundred twenty-three patients (81%) demonstrated increased (18)F-fluorodeoxyglucose uptake. The overall sensitivity and specificity of PET for detecting malignancy were 95% and 67%, respectively, compared with 100% and 27% for chest CT. PET and CT had similar accuracy for staging the overall extent of disease (91% and 89%, respectively). PET stage correlated highly with survival using either nodal location or overall stage (p = 0.003, p = 0.002), as did pathologic staging (p = 0.0001, p = 0.0001). CT scan results did not accurately predict survival (p = 0.608, p = 0.338). CONCLUSION: PET scanning is a highly sensitive technologic advance in detecting and staging of thoracic malignancy and may more accurately predict the likelihood of long-term survival in patients with NSCLC than chest CT does.     

The utility of fluorodeoxyglucose positron emission tomography in the evaluation of carcinoid tumors presenting as pulmonary nodules

BACKGROUND: Fluorodeoxyglucose positron emission tomography (FDG-PET) is sensitive for detection of neoplastic solitary pulmonary nodules but may have decreased sensitivity for detection of carcinoid tumors. Our purpose was to determine the sensitivity of FDG-PET to detect pulmonary carcinoid tumors. METHODS: We performed a retrospective review of our institutional results regarding FDG-PET in the setting of thoracic carcinoid neoplasms. We identified 16 patients with a pathologic diagnosis of bronchial carcinoid who had an antecedent FDG-PET (from 2000 to 2004). All patients but one presented with pulmonary nodule(s). RESULTS: Sixteen patients had a diagnosis of carcinoid tumor, typical in 11 patients and atypical in 5 patients. The mean greatest pathologic dimension was 2.08 cm (range, 1.0 to 8.3 cm). Overall positron emission tomography (PET) sensitivity was 75% (12 true-positive and 4 false-negative results). The mean (+/- SD) size of carcinoids with false-negative PET results was not significantly different from carcinoids with true-positive results (1.6 +/- 0.81 cm and 2.35 +/- 1.87 cm, p = 0.54). Fifteen of 16 patients were staged pathologically, and positive nodes were found in 2 of these patients. PET lymph node staging agreed with pathologic staging in one stage 4 patient with positive lymph nodes and distant metastasis, but PET results were false negative in the other patient who had N2 with micrometastatic disease; stage IIIA. CONCLUSIONS: FDG-PET imaging is useful for evaluation of typical and atypical thoracic carcinoid tumors. Although overall PET sensitivity for detection of carcinoid tumors is somewhat reduced as compared to non-small cell lung cancer, it is much higher than prior reports suggest.     

39例飞行人员肺结节临床特点及诊治初探

目的探讨飞行人员肺结节的临床诊治特点及鉴定原则。方法回顾性分析2000年1月至2019年3月空军特色医学中心39例肺结节患者的病史、X线胸片、胸部CT、PET/CT等结果,以及肺结节的诊治经过、飞行鉴定等资料,进行统计分析。结果39例飞行人员肺结节患者中,发现时22例(56.4%)无呼吸道症状,X线胸片检查31例,所有患者均行胸部CT检查,其中16例(51.6%)X线胸片检查与胸部CT检查一致,PET/CT检查14例(35.9%)。首次影像学检查显示恶性结节与良性结节、性质待定结节相比,发现时最大径最大、长短径比值最小(P值均<0.05),随访影像学显示,恶性结节与其它两类结节相比,最大径变化幅度、面积变化幅度均为最高(P值均<0.05)。胸部CT检查提示良、恶性结节密度、空泡征、边缘、分叶、毛刺比较,差异均有统计学意义(P值均<0.05);二者分布、边界及与血管关系比较差异均无统计学意义(P值均>0.05)。发现结节就诊时,27例(69.2%)均在3个月以上的地面观察后做出飞行结论。结论X线胸片用于肺结节的常规评估容易漏诊,胸部CT可进行评估和随访,PET/CT检查是CT检查的良好补充,有助于区分良恶性。发现肺结节后,无统一的飞行结论时间及流程、标准。