SPECT骨显像联合血清碱性磷酸酶检测评估肺癌患者骨转移负荷的价值

目的:探讨SPECT骨显像结合碱性磷酸酶(ALP)评估初诊肺癌骨转移负荷的价值.方法:109例初诊未治疗肺癌患者行99Tcm-MDP SPECT全身骨显像,其中发生骨转移51例,无骨转移58例;根据骨显像发现骨病灶数目及受累情况,将骨显像分为0-3级,并检测血清ALP水平;比较各组骨显像分级ALP水平,进行相关分析.结果:109例初诊肺癌患者,转移率46.8％ (51/109);骨显像1-3级患者存在外周血ALP不同程度增高,波动范围127 ～ 782 U/L;0-3级各组ALP检测值分别为(110.26 ±42.13) U/L,58例]、(138.85±86.72) U/L,16例]、(267.84±147.52) U/L,15例]、(481.46 ±289.73) U/L,20例].各组ALP水平除骨显像0级组与1级组之间差异无统计学意义(t=1.346,P＞0.05);其它各组随着骨显像分级升高,ALP值逐渐增高,且各组间差异有统计学意义(P＜0.05).血清ALP水平与骨显像分级呈正相关(r=0.945,P＜0.01).骨显像1级组中有4例患者,每例有2个异常浓聚灶,其中1个病灶经CT或MRI确定为骨转移,但另外1个病灶不能确定是否骨转移;2例患者ALP升高,2例ALP正常;随访半年,2例ALP正常患者的病灶排除骨转移,另外2例ALP升高患者的病灶确定为转移.结论:SPECT骨显像结合初诊肺癌ALP水平对评估肺癌骨转移负荷存在一定价值;值得临床重视与应用,以合理地肺癌分级等.

Evaluate of the value of bone metastases burden by SPECT bone imaging combined with serums alkaline phosphalase in patients with lung cancer

Objective:To investigate the value of SPECT bone imaging combined with levels of alkaline phosphatase(ALP) in evaluating bone metastases burden in patients with newly diagnosed lung cancer.Methods:The bone lesions were determined by 99Tcm-MDP SPECT whole body bone scan,and some combined with CT or MRI.In 109 cases of newly diagnosed untreated patients with lung cancer,there were bone metastases in 51 cases,58 cases without bone metastases.According to the numbers of found and involvement of bone lesions,the results will be divided into 0 -3 grade of bone metastases burden with detected serum ALP levels.The correlations between each grade of bone metastases burden and the levels of ALP were analyzed.Results:In 109 cases of newly diagnosed lung cancer pa tients,the incidence rate bone metastasis is 46.8％ (51/t09).The levels of peripheral blood ALP increased to varying degrees(127-782) U/L in patients with grade 1-3.The ALP levels of 0-3 grade respectively were (110.26 ± 42.13) U/L,58 cases],(138.85 ±86.72) U/L,16 cases],(267.84 ± 147.52) U/L,15 cases],(481.46 ± 289.73) U/L,20 caes].The difference of ALP levels was not statistically significant between class 0 and 1 grade (t =1.346,P ＞ 0.05);ALP levels gradually increased in other grade,and there was significant difference between the each grade(P ＜0.05).There was a positive correlation between the level of serum ALP increased and the grade of each group of bone imaging in each group(r =0.945,P ＜ 0.01).4 patients of bone imaging grade 1 group had two abnormal increase uptake lesions,one lesion to determine bone metastasis by CT or MRI,but the other one cannot exactly determine whether with bone metastasis or not.Among them,2 cases of patients with elevated ALP,2 cases with normal ALP level.Follow up six months later,2 cases of patients with normal ALP excluded bone metastasis lesions,another 2 cases of patients were with elevated ALP diagnosed with bone metastasis.Conclusion:There is a certain value to assess bone metastases burden by SPECT bone imaging combined with ALP level of newly diagnosed untreated patients with lung cancer,and this is worthy of clinical attention and application,in order to accurate staging lung cancer.