摘要
目的探讨18F脱氧葡萄糖（FDG）-PET-CT对皮肌炎的诊断价值及其对皮肌炎疾病活动度和缓解的评价。方法选2012年1月至2015年5月解放军总医院收治的接受18FFDG．PET．CT检查住院的皮肌炎患者58例，另选与之年龄和性别匹配的健康体检者29例，记录并比较受试者近端肢带肌群（上臂肌肉、肩部肌肉、颈胸腰椎旁肌肉、胸锁乳突肌、臀部肌肉、股部上份肌肉）的标准化摄取值（SUV），分析其相关性及诊断价值。结果皮肌炎患者肌肉SUV为（2．033±0．858）g／ml，高于健康体检者（1．076±0．167）g／ml（P〈0．001）。典型皮肌炎患者肌肉SUV为（2．105±0．736）g/ml，亚临床型皮肌炎患者肌肉SUV为（1．463±0．291）g／ml，高于健康体检者（P值均〈0．05）。典型皮肌炎患者上臂肌肉、肩部肌肉、臀部肌肉SUV高于亚临床型皮肌炎患者（P值均〈0．05）。皮肌炎初治患者肌肉SUV为（1．051±0．031）g/ml，与初治亚临床型皮肌炎患者比，初治典型皮肌炎患者上臂、肩部、臀部肌肉SUV高，但差异无统计学意义（P值均〉0．05）。初治3个月疾病缓解者肌肉SUV明显小于3—6个月疾病缓解者[（1．746±0．466）g／ml比（2．815±0．848）g／ml；P=0．015]。相关分析显示，初治患者上臂肌力与上臂肌肉SUV呈负相关（rs=-0．440，P=0．031）；肌酸激酶水平与上臂肌肉SUV呈正相关（rs=0．500，P=0．013）。ROC曲线分析显示，肌肉SUV最佳临界值为1．375g／ml，诊断皮肌炎的敏感度为82．8％，特异度为96．6％，AUCROC为0．953。单因素logistic回归分析显示，年龄、上臂肌肉SUV、颈椎旁肌肉SUV、臀部肌肉SUV、股部上份肌肉SUV是影响疾病缓解的危险因素。结论18FFDG．PET—CT测定的近端肢带肌群SUV对皮肌炎具有诊断价值，上臂肌肉SUV与上臂肌力、肌酸激酶水平具有相关性，可反映疾病活动度。18F FDG—PET—CT可以作为评估皮肌炎疾病缓解的检查手段之一。
Objective To investigate the value of lSF fluorodeoxyglucose-positron emission tomography/eomputed tomography （lSF FDG-PET-CT） in the diagnosis and the evaluation of disease activity and remission of dermatomyositis （ DM ）. Methods DM patients who were admitted to the Department of Rheumatology, the People＇s Liberation Army General Hospital （PLAGH） and underwent lSF FDG-PET-CT examination were retrospectively reviewed from January 2012 to May 2015. Gender and age matched healthy controls （HC） were also enrolled. The standardized uptake value （SUV） of proximal limb girdle muscles in both groups were recorded and compared, so as between patients with DM or subclinical DM. The correlation between myodynamia of proximal limb girdle muscle, creatine kinase （ CK ） , CK-MB, serum ferritin and SUV of each muscle group were analyzed, Results There were 58 patients with DM and 29 controls consecutively recruited in the study. The SUV of upper arms （1. 814±0. 830） g/ml, shoulders （2. 134 ±0. 797） g/ml and hips （ 1. 883 ± 0. 683 ） g/ml in patients with classic DM were significantly higher than those with subclinical DM [ （0. 938 ± 0. 218 ） g/ml, （ 1. 152 ±0. 315 ） g/ml, （0. 945± 0. 249） g/ml;P 〈0. 05 ]. SUV of muscles in newly diagnosed patients was （ 1.051 ±0. 031 ） g/ml, which was higher than that in subclinical patients. But the difference was not statistically significant （P 〉 0.05 ）. The average SUV of evaluated muscles in DM group （2. 033±0. 858 ） g/ml was significantly higher than that in controls （ 1. 076± 0. 167 ） g/ml （ P 〈 0. 001 ）. Receiver operating characteristic （ ROC ） analysis revealed the area under the curve（AUC） of abnormal SUV detected by 18F FDG-PET-CT for diagnosing DM was 0. 953. The myodynamia of upper arms and SUV was negatively correlated （rs = -0. 440, P = 0. 031 ）. However, the level of serum creatine kinase and SUV was positively correlated （rs = 0. 500, P = 0. 013 ）. The average SUV of patients whose time to remission was less than 3 months （ 1. 746±0. 466） g/ml was obviously less than that of patients with 3 to 6 months to obtain remission （2. 815 ± 0. 848 ） g/ml （ P = 0. 015 ）. Conclusions The SUV of proximal limb girdle muscles detected by lSF FDG-PET-CT has a positive diagnostic value for DM. Moreover, the SUV in upper arms is correlated with the muscle strength and the level of creatine kinase, which reflect disease activity. 18F FDG-PET-CT might be an alternative method to evaluate the response of treatment.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2016年第7期525-530,共6页
Chinese Journal of Internal Medicine
关键词
正电子发射断层显像
皮肌炎
肌力
肌酸激酶
Positron-emission tomography
Dermatomyositis
Muscle strength
Creatine kinase
