99Tcm-奥曲肽眼眶显像在甲状腺相关眼病中的临床应用

目的 研究99Tcm-奥曲肽眼眶显像在判断甲状腺相关眼病(TAO)患者眼部炎性反应活动度中的临床价值.方法 根据临床活动度评分(CAS)标准,将30例TAO患者分为活动组和非活动组,11例正常志愿者为对照组.所有对象行99Tcm-奥曲肽眼眶断层显像,并计算眼眶奥曲肽摄取比值(UR).6例活动组患者于抗炎治疗后进行了二次显像.结果 3组眼眶的奥曲肽UR均数分别为1.40±0.18、1.15±0.10及1.07±0.20,活动组与非活动组、对照组两两相比,差异均有统计学意义(均P＜0.001);非活动组与对照组相比,差异无统计学意义(P＞0.05).所有TAO患者的UR与其CAS具有良好的相关性(rall= 0.859,P＜0.001).对活动组患者的治疗前后UR比较,差异有统计学意义(t=4.39,P=0.007).治疗前后CAS比较,差异有统计学意义(Z=-5.51,P＜0.001),表明治疗后评分降低,治疗有效.结论 99Tcm-奥曲肽眼眶显像可帮助临床医师判断TAO炎性反应活动度,为制订治疗方案提供依据,并可用于疗效评价.

Clinical application of orbital scintigraphy with 99Tc(m)-octreotide in patients with thyroid associated ophthalmopathy

OBJECTIVE: To analyze the feasibility of estimation of thyroid associated ophthalmopathy (TAO) activity with orbital scintigraphy using 99Tcm-octreotide. METHODS: There were 30 cases of TAO and 11 volunteers without eye disease or thyroid disease (control group, CG). Some examinations were performed before treatment. Based on the clinical activity score (CAS) , all TAO patients were divided into 2 groups, active group (AG) and inactive group (IAG). Orbit scintigraphy study of orbit was completed within 1. 0 - 1. 5 h after intravenous injection of 740 MBq 99Tcm-octreotide. The best transverse slice for displaying eye was selected to take semi quantitative analysis. The regions of interest of right orbit (R) , left orbit (L) and occipital (0) were selected. The uptake ratios (UR) were calculated in (R + L)/20. And then, all active patients accepted immunosuppressive therapy with prednisone after 131I therapy. Six patients performed octreotide scan twice. The statistical analyses included ANOVA, Spearman regression analysis and paired t-test using SPSS 10. 0. RESULTS: 99Tcm-octreotide biokinetics showed a rapid blood clearance through urinary system. The orbit appeared as a "cold area" in CG. The orbit uptake of AG had a visual orbital accumulation of 99Tcm-octreotide, but little in IAG ( URact = 1.40 +/-0. 18, URinact = 1. 15+/-0. 10, URcontr= 1. 07 +/-0. 20). There was a significant difference between IAG and AG of UR (P <0. 001). A statistically significant correlation was found between CAS and UR (URall vs. CASall r = 0. 859,P <0. 001). After 12 weeks treatment with prednisone, the signs and symptoms of inflammation had lightened, UR pretreat vs. UR posttreat(t = 4. 39, P = 0. 007) ; CAS pretreat vs. CAS posttreat ( Z = - 5. 51, P < 0. 001 ). CONCLUSIONS: Orbital scintigraphy with 99Tcm-octreotide is a method for judging activity of inflammation in TAO based on the distribution of somatostatin receptors, lymphocyte infiltration and fibroblast activating in retrobulbar tissue. There is a good correlation between CAS and UR. The scintigraphy can estimate activity of TAO and help to formulate therapy program and evaluate the therapeutic effects.