相对低剂量甲泼尼龙联合99Tc-MDP治疗老年Graves眼病的疗效观察

目的评价相对低剂量甲泼尼龙短程疗法联合99Tc-亚甲基二膦酸盐（99Tc-MDP）治疗老年活动性中重度Graves眼病（GO）的临床疗效及安全性。方法24例老年活动性中重度GO患者先配对后随机分入对照组及试验组各12例。对照组应用常规大剂量甲泼尼龙问断静脉短程冲击治疗,累积剂量达800．1200mg。试验组应用相对低剂量甲泼尼龙（累积剂量为300-480mg）联合99Tc-MDP的治疗方案。治疗前及开始治疗后每1～4周进行定期随访观察,并根据眼病临床活动性评分及美国甲状腺协会提出的甲状腺相关眼病分度分级标准评定眼部病情变化,同时监测治疗后的不良反应。应用Ridit检验进行统计分析,比较两组疗效。结果试验组10例患者有效,对照组6例患者有效,两组的疗效有统计学差异（t=2．121,P〈0．05）。对照组的不良反应明显增多,主要体现于消化道症状,引起或加重水钠潴留与糖代谢紊乱。结论对于老年活动性中重度GO应用相对低剂量甲泼尼龙短程疗法联合99Tc-MDP是一种临床疗效及安全性较好的治疗方案。     

甲泼尼龙冲击联合曲安奈德球后注射治疗甲状腺相关眼病临床疗效

目的探讨甲泼尼龙冲击治疗联合曲安奈德球后注射治疗甲状腺相关眼病的临床疗效。方法对中重度甲状腺相关眼病(TAO)患者38例,给予甲泼尼龙500 mg,隔日1次,连续3次,并联合1次曲安奈德球后注射作为1个疗程,每月1个疗程。连续3个疗程后,评价眼部自觉症状、体征和不良反应,并对影响治疗效果的因素进行相关分析。结果甲泼尼龙冲击联合曲安奈德球后注射治疗3个疗程后,患者的眼部自觉症状、临床活动性评分(CAS)、突眼度、眼裂宽度、软组织炎症评分明显下降,CAS下降的程度与眼病病程呈明显负相关(r=-0.423,P<0.01)。结论甲泼尼龙冲击治疗联合曲安奈德球后注射治疗甲状腺相关眼病的疗效确切,安全可靠,不良反应少。     

大剂量甲泼尼龙治疗急性视神经炎疗效观察

1995～1996年,我们采用大剂量甲泼尼龙治疗急性视神经炎,并与常规用地塞米松治疗法进行对照。结果表明,大剂量甲泼尼龙治疗组疗效优于地塞米松对照组。1　对象和方法1.1　对象　均按文献〔1〕标准确诊。急性视神经炎62例,随机分为两组:(1)治疗组33例65眼。男25例,女8例;年龄21～37岁,平均29岁。发病时间:3～13d,平均8d。视力:指数30cm至0.15。双眼视神经乳头炎11例,单眼5例;双眼球后视神经炎17例,单眼4例;(2)对照组29例43眼,男12例,女17例;年龄17～51岁,平均34岁。发病时间:2～11d,平均6.5d。视力:指数20cm至0.2。双眼视神经乳头炎6例,单眼1…     

大剂量甲泼尼龙治疗视神经脊髓炎临床观察

视神经脊髓炎(neuromyelitis optica,NMO)又称Devic病或Devic综合征,主要特点是合并有视神经与脊髓的脱髓鞘性病变,以往应用常规剂量皮质类固醇治疗,疗效大多不满意,常遗有失明、肢体瘫痪甚至死亡,近年来我们对12例较重的视神经脊髓炎患者进行了甲泼尼龙冲击疗法(methylprednisolone pluse therapy,MPPT),效果较好,现报告如下.     

99Tcm-MDP骨显像胸部异常放射性摄取的原因分析

在99Tcm-MDP骨显像时除全身正常组织及病变骨组织显影外,骨外组织也常不同程度地摄取显像剂而显影,尤以胸部软组织最为常见。研究胸部骨与骨外组织摄取显像剂显像的不同原因,分析其可能蕴含的病变信息,给临床诊疗提供必要的帮助。笔者就近年来有关这方面国内外的研究进行综述。     

大剂量甲泼尼龙冲击联合丙种球蛋白治疗重症脱髓鞘脑病2例

脱髓鞘疾病是以神经系统白质脱髓鞘为主要病理改变的疾病,其发病机制与免疫异常有关[1],重症患者常规治疗效果差、并发症和后遗症多、病死率高,目前缺乏统一有效的治疗方法.本文对2例确诊的已行过激素冲击治疗疗效不佳的重症脱髓鞘脑病患者,再次采取大剂量甲泼尼龙冲击和静滴丙种球蛋白、神经节苷脂联合治疗,取得良好效果,现报道如下.     

131I治疗对Graves眼病转归的影响

目的 分析131I治疗后Graves甲状腺功能亢进症(甲亢)疗效与Graves眼病转归的相关关系,探讨131I治疗对Graves眼病转归的影响.方法 652例Graves甲亢合并Graves眼病的患者,均按照常规程序一次性给予治疗量的131I.服用131I前测量患者眼球突出度,并详细记录眼部症状和特征.治疗结束后定期随...     

99Tcm-MDP全身骨显像受检者外照射剂量的研究

目的 研究99Tcm-亚甲基二膦酸盐（MDP）全身骨显像受检者对非核医学科人员的外照射剂量,以有效减少非受检者的受照辐射剂量。 方法 选取 2018年8月至2019年1月在中国科学技术大学附属第一医院行99Tcm-MDP全身骨显像的51例受检者进行回顾性研究,其中男性26例、女性25例,年龄22~91（62.23±13.36）岁。所有受检者注射925 MBq 99Tcm-MDP后,根据饮水1000 mL后0.5 h内有无排尿分为排尿组（n=39）和未排尿组（n=12）,检测注射药物后0.5、1、2、3、4、6 h时受检者腹部和头部水平距离0.5、1、2、4、6 m处的辐射剂量当量率和累积剂量当量。2组间比较采用两独立样本的Mann-Whitney U检验,多次测量的不同时间、不同距离辐射剂量当量率的比较采用重复测量方差分析,配对样本采用非参数Wilcoxon检验。 结果 排尿组受检者在腹部水平距离0.5、1、2、4、6 m处的辐射剂量当量率均低于未排尿组[（40.29±4.67）μSv/h对（77.29±10.71）μSv/h、（15.22±1.64）μSv/h对（29.48±4.56）μSv/h、（4.15±0.47）μSv/h对（7.45±1.07）μSv/h、（1.32±0.10）μSv/h对（2.63±0.31）μSv/h、（0.45±0.05）μSv/h对（0.78±0.15）μSv/h],且差异均有统计学意义（Z=5.148~5.251,均P<0.001）。排尿组受检者腹部和头部的辐射剂量当量率均随着时间和距离的增加而迅速降低,且差异有统计学意义（F=3105.426~5397.675,均P<0.001）;排尿组受检者的辐射剂量当量率随着药物注射后时间的延长而显著下降。与排尿组受检者腹部水平距离0.5 m处6 h的累积剂量当量[（148.51±13.83）μSv]相比,1 m处6 h的累积剂量当量[（55.85±5.22）μSv]显著下降,且差异有统计学意义（Z=5.610,P<0.001）;与排尿组受检者头部水平距离0.5 m处6 h的累积剂量当量[（132.74±12.95）μSv]相比,1 m处6 h的累积剂量当量[（49.88±4.72）μSv]显著下降,且差异有统计学意义（Z=5.438,P<0.001）;排尿组受检者的累积剂量当量随着照射时间的延长而增加、随着距离的增加而减少。 结论 99Tcm-MDP全身骨显像对于非核医学科人员的照射剂量远远小于国内、国际法律规定限值（个人年有效剂量当量≤1 mSv）,与注射药物后3 h的受检者距离1 m以上即可避免大部分额外辐射。     

甲泼尼龙与环磷酰胺联合冲击治疗大疱性类天疱疮

目的　探讨甲泼尼龙与环磷酰胺联合冲击治疗大疱性类天疱疮的临床疗效与不良反应。方法　甲泼尼龙连续用药 3d为 1个疗程 ,第 1,2 ,3d分别静滴 30 0mg ,2 0 0mg ,2 0 0mg ,必要时 1周后行下一疗程治疗 ;环磷酰胺 6 0 0mg ,静滴 ,每周 1次。结果　 8例病人中 1疗程控制 7例 ,2疗程控制 1例 ,2月内皮质类固醇激素 (泼尼松 )减量至 5 0mg/d以下 ;冲击治疗期间 ,白细胞总数、血压有不同程度增高 ,2例出现低血钾 ,糖尿病患者血糖变化明显。结论　本疗法具有起效快、病情控制迅速、有利于激素减量 ,是治疗大疱性类天疱疮的有效的治疗方法之一 ,但对有合并症患者应慎用     

甲泼尼龙联合巴曲酶注射液在突发性耳聋患者中的治疗效果研究

目的 分析甲泼尼龙联合巴曲酶的应用价值。方法 分析2019年1月-2022年3月137例突发性耳聋患者,按照治疗方案分组。对照组68例单用甲泼尼龙治疗,观察组69例患者则加用巴曲酶。比较两组疗效以及不良反应差异,同时观察两组治疗前后听阈值以及血液流变学指标(纤维蛋白原、血沉)的变化。结果 研究观察组总有效率为92.8%(64/69),对照组仅有80.9%(55/68),观察组总有效率高于对照组(P<0.05);观察组不良反应发生率为7.2%(5/69),对照组为5.9%(4/68),两组不良反应差异无统计学意义(P>0.05);观察组治疗前后听阈值分别为(58.6±20.6)dBHL和(33.2±12.4)dBHL,纤维蛋白原分别为(3.7±0.8)g/L和(2.9±0.3)g/L,血沉分别为(17.3±2.6)mm/h和(12.3±0.6)mm/h;对照组治疗前后听阈值分别为(58.5±20.4)dBHL和(38.5±15.4)dBHL,纤维蛋白原分别为(3.8±0.9)g/L和(3.5±0.6)g/L,血沉分别为(17.2±2.5)mm/h和(15.1±1.0)mm/h...     

^99Tc^m-二亚乙基三胺五乙酸与^99Tc^m-奥曲肽眼眶显像在甲状腺相关性眼病中的对比研究

目的通过对比^99Tc^m-二亚乙基三胺五乙酸（^99Tc^m-DTPA）与^99Tc^m-奥曲肽（^99Tc^m-OCT）眼眶显像,比较两种显像方法在评估甲状腺相关眼病（TAO）患者眼部炎性反应活动度中的临床价值。方法26例TAO患者依据临床活动度评分（CAS）标准分为炎性反应活动组16例、非炎性活动组10例,另有14名正常志愿者作为对照组。静脉注射^99Tc^m-DTPA 740 MBq,0．5h后行眼眶平面及体层显像,隔日同一患者静脉注射^99Tc^m-OCT740MBq,1-2h后行眼眶平面及体层显像。获取各组两种眼眶显像剂的摄取率。对两种显像方法获得的半定量指标UROCT和URDTPA进行配对t检验并分别与CAS评分进行Spearman相关性分析。结果两种显像剂的眼眶摄取率未见明显差异（t=0．075,P〉0．05）。两种显像剂的眼眶摄取率（UROCT、URDTPA）与患者CAS评分之间具有很好的相关性（^99Tc^m-DTPA：r=0．835,P〈0．001;^99Tc^m-OCT：r=0．912,P〈0．001）。结论^99Tc^m-DTPA与^99Tc^m-OCT的眼眶显像有较好的一致性,证明^99Tc^m-DTPA眼眶显像是一种可行的、并可能成为一种很有发展前景的评价TAO炎性反应活动度的新方法。     

~(99)Tc~m-甲氧基异丁基异腈显像在分化型甲状腺癌随访中的应用

分化型甲状腺癌(DTC)在经过手术、放射性碘治疗、甲状腺激素抑制治疗后,仍需终身随诊.目前DTC的日常随诊方法如常规影像学方法、甲状腺球蛋白测定和~(131)I全身显像仍有其不足之处,临床上常常发现一些患者存在不摄碘的失分化病灶,定位这些失分化的病灶,对确定患者的进一步治疗至关重要.肿瘤阳性显像剂~(99)Tc~m-甲氧基异丁基异腈(~(99)Tc~m-MIBI),由于其良好的物理和剂量测量方面的特性,价格便宜,国内外对其在DTC随访中的作用做了大量基础及临床研究.本综述主要从原理、显像方法、显像结果分析、优势介绍~(99)Tc~m-MIBI显像在DTC随访的应用.     

99Tcm-DTPA SPECT/CT眼眶显像在甲状腺相关性眼病诊疗中的应用进展

甲状腺相关性眼病（TAO）对患者的生活质量、心理健康以及社会经济都造成了严重的负面影响,在该病的早期活动期进行治疗的效果较好,目前该病的活动性分期主要采用临床活动性评分（CAS）,其存在较多不足之处。近年来,99Tcm-二亚乙基三胺五乙酸（DTPA） SPECT/CT眼眶显像在TAO的早期诊断、治疗和随访中都显示出重要价值,其可以与CAS互相补充,应用前景广阔。笔者总结了目前该领域的研究进展,提出未来需要更多的研究以期建立标准化的采集和结果分析共识,进一步研究一种新的TAO筛选工具,将99Tcm-DTPA SPECT/CT眼眶显像与人工智能技术相结合,以便更加精准便捷地指导临床。     

99Tcm-二亚乙基三胺五乙酸与99Tcm-奥曲肽眼眶显像在甲状腺相关性眼病中的对比研究

Objective Through a comparative study of 99Tcm-diethylenetriaminepentaacetic acid (99Tcm-DTPA) and 99Tcm-octreotide (99Tcm-OCT) SPECT orbital scan, evaluated the clinic significance of two imaging of estimation activity in thyroid associated ophthalmopathy (TAO). Methods Aeording to the elinnic activity score (CAS), 26 TAO patients were divided into two groups: active group (CAS ≥3) and inactive group (CAS<3), 14 volunteers (control group) participates this study. Orbit scan were completed after intravenously injection with 99Tcm-DTPA 740 MBq and 99Tcm-OCT (every other day). Obtaining the uptake ratio (UR) of two kinds of orbit scans. The statistical analyses included Paired-samples t test analysis of variance and Spearman regression analysis. Results There is no statistically significance between the two methods in UR (t=0.075, P>0.05). There is a statistically significant correlation was found between CAS and the uptake ratios(99Tcm-DTPA: r=0.835, P<0.001; 99Tcm-OCT: r=0.912, P<0.001). Conclusions There is a good uniformity between 99Tcm-DTPA and 99Tcm-OCT orbital scan; 99Tcm-DTPA is a feasible and maybe a new promising estimation method of activity in the patients with TAO.     

99Tcm-二亚乙基三胺五乙酸与99Tcm-奥曲肽眼眶显像在甲状腺相关性眼病中的对比研究

Objective Through a comparative study of 99Tcm-diethylenetriaminepentaacetic acid (99Tcm-DTPA) and 99Tcm-octreotide (99Tcm-OCT) SPECT orbital scan, evaluated the clinic significance of two imaging of estimation activity in thyroid associated ophthalmopathy (TAO). Methods Aeording to the elinnic activity score (CAS), 26 TAO patients were divided into two groups: active group (CAS ≥3) and inactive group (CAS<3), 14 volunteers (control group) participates this study. Orbit scan were completed after intravenously injection with 99Tcm-DTPA 740 MBq and 99Tcm-OCT (every other day). Obtaining the uptake ratio (UR) of two kinds of orbit scans. The statistical analyses included Paired-samples t test analysis of variance and Spearman regression analysis. Results There is no statistically significance between the two methods in UR (t=0.075, P>0.05). There is a statistically significant correlation was found between CAS and the uptake ratios(99Tcm-DTPA: r=0.835, P<0.001; 99Tcm-OCT: r=0.912, P<0.001). Conclusions There is a good uniformity between 99Tcm-DTPA and 99Tcm-OCT orbital scan; 99Tcm-DTPA is a feasible and maybe a new promising estimation method of activity in the patients with TAO.     

99Tcm-二亚乙基三胺五乙酸与99Tcm-奥曲肽眼眶显像在甲状腺相关性眼病中的对比研究

Objective Through a comparative study of 99Tcm-diethylenetriaminepentaacetic acid (99Tcm-DTPA) and 99Tcm-octreotide (99Tcm-OCT) SPECT orbital scan, evaluated the clinic significance of two imaging of estimation activity in thyroid associated ophthalmopathy (TAO). Methods Aeording to the elinnic activity score (CAS), 26 TAO patients were divided into two groups: active group (CAS ≥3) and inactive group (CAS<3), 14 volunteers (control group) participates this study. Orbit scan were completed after intravenously injection with 99Tcm-DTPA 740 MBq and 99Tcm-OCT (every other day). Obtaining the uptake ratio (UR) of two kinds of orbit scans. The statistical analyses included Paired-samples t test analysis of variance and Spearman regression analysis. Results There is no statistically significance between the two methods in UR (t=0.075, P>0.05). There is a statistically significant correlation was found between CAS and the uptake ratios(99Tcm-DTPA: r=0.835, P<0.001; 99Tcm-OCT: r=0.912, P<0.001). Conclusions There is a good uniformity between 99Tcm-DTPA and 99Tcm-OCT orbital scan; 99Tcm-DTPA is a feasible and maybe a new promising estimation method of activity in the patients with TAO.     

99Tcm-二亚乙基三胺五乙酸与99Tcm-奥曲肽眼眶显像在甲状腺相关性眼病中的对比研究

Objective Through a comparative study of 99Tcm-diethylenetriaminepentaacetic acid (99Tcm-DTPA) and 99Tcm-octreotide (99Tcm-OCT) SPECT orbital scan, evaluated the clinic significance of two imaging of estimation activity in thyroid associated ophthalmopathy (TAO). Methods Aeording to the elinnic activity score (CAS), 26 TAO patients were divided into two groups: active group (CAS ≥3) and inactive group (CAS<3), 14 volunteers (control group) participates this study. Orbit scan were completed after intravenously injection with 99Tcm-DTPA 740 MBq and 99Tcm-OCT (every other day). Obtaining the uptake ratio (UR) of two kinds of orbit scans. The statistical analyses included Paired-samples t test analysis of variance and Spearman regression analysis. Results There is no statistically significance between the two methods in UR (t=0.075, P>0.05). There is a statistically significant correlation was found between CAS and the uptake ratios(99Tcm-DTPA: r=0.835, P<0.001; 99Tcm-OCT: r=0.912, P<0.001). Conclusions There is a good uniformity between 99Tcm-DTPA and 99Tcm-OCT orbital scan; 99Tcm-DTPA is a feasible and maybe a new promising estimation method of activity in the patients with TAO.     

99Tcm-二亚乙基三胺五乙酸与99Tcm-奥曲肽眼眶显像在甲状腺相关性眼病中的对比研究

Objective Through a comparative study of 99Tcm-diethylenetriaminepentaacetic acid (99Tcm-DTPA) and 99Tcm-octreotide (99Tcm-OCT) SPECT orbital scan, evaluated the clinic significance of two imaging of estimation activity in thyroid associated ophthalmopathy (TAO). Methods Aeording to the elinnic activity score (CAS), 26 TAO patients were divided into two groups: active group (CAS ≥3) and inactive group (CAS<3), 14 volunteers (control group) participates this study. Orbit scan were completed after intravenously injection with 99Tcm-DTPA 740 MBq and 99Tcm-OCT (every other day). Obtaining the uptake ratio (UR) of two kinds of orbit scans. The statistical analyses included Paired-samples t test analysis of variance and Spearman regression analysis. Results There is no statistically significance between the two methods in UR (t=0.075, P>0.05). There is a statistically significant correlation was found between CAS and the uptake ratios(99Tcm-DTPA: r=0.835, P<0.001; 99Tcm-OCT: r=0.912, P<0.001). Conclusions There is a good uniformity between 99Tcm-DTPA and 99Tcm-OCT orbital scan; 99Tcm-DTPA is a feasible and maybe a new promising estimation method of activity in the patients with TAO.     

99Tcm-二亚乙基三胺五乙酸与99Tcm-奥曲肽眼眶显像在甲状腺相关性眼病中的对比研究

Objective Through a comparative study of 99Tcm-diethylenetriaminepentaacetic acid (99Tcm-DTPA) and 99Tcm-octreotide (99Tcm-OCT) SPECT orbital scan, evaluated the clinic significance of two imaging of estimation activity in thyroid associated ophthalmopathy (TAO). Methods Aeording to the elinnic activity score (CAS), 26 TAO patients were divided into two groups: active group (CAS ≥3) and inactive group (CAS<3), 14 volunteers (control group) participates this study. Orbit scan were completed after intravenously injection with 99Tcm-DTPA 740 MBq and 99Tcm-OCT (every other day). Obtaining the uptake ratio (UR) of two kinds of orbit scans. The statistical analyses included Paired-samples t test analysis of variance and Spearman regression analysis. Results There is no statistically significance between the two methods in UR (t=0.075, P>0.05). There is a statistically significant correlation was found between CAS and the uptake ratios(99Tcm-DTPA: r=0.835, P<0.001; 99Tcm-OCT: r=0.912, P<0.001). Conclusions There is a good uniformity between 99Tcm-DTPA and 99Tcm-OCT orbital scan; 99Tcm-DTPA is a feasible and maybe a new promising estimation method of activity in the patients with TAO.