唾液腺动态显像对口干患者唾液腺功能受损的诊断评价

摘要

ObjectiveTo investigate a semi-quantitative method of evaluating salivary gland function in patients with xerostomia.Methods 22 patients with xerostomia from suspected Sjögren’s syndrome underwent Tc99m-pertechnetate salivary gland scintigraphy(SGS). Visual assessment of the dynamic images, time-activity curves, uptake rate at 1-3 minutes(UR1-3min)and 18 minutes (UR18min), gland to background ratio at 18 minutes, and time to peak counts(Tmin)were determined. 8 patients who underwent thyroid scintigraphy were included as the control group. The analysis of variance method was used to compare the parameters among the two groups.Results Salivary dysfunction was detected on 18/22(82%)patients and 4/22(18%)of patients were normal. The bilateral submandibular glands were affected simultaneously with the parotid glands. There was significant difference in the UR1-3min and UR18min of patients with severe salivary dysfunction and other groups, in the UR18min of patients with normal function, moderate dysfunction and control group. There was no significant difference in the Tmin between patients with normal function and control group. Salivary gland excretion was considerably decreased in the moderate and severe dysfunction groups. Antibody against ds-DNA was negative in all patients. Antibodies against SSA/SSB(8), ANA(10), and RF(8)were positive. There was significant difference in the degree of salivary gland dysfunction between the groups with and without antibodies against SSA/SSB.Conclusion SGS is sensitive and accurate for diagnosing salivary gland dysfunction in patients with xerostomia. Salivary gland dysfunction was aggravated by antibody against SSA/SSB.%目的探讨唾液腺动态显像（salivary gland scintigraphy, SGS）对疑为干燥综合征口干患者唾液腺功能受损的诊断评价，并探讨定量功能参数的临床意义。方法疑为干燥综合征口干患者22例行Tc99mO4- SGS，通过肉眼影像、时间-放射性曲线和功能参数定量分析（前3min的初始摄取率UR1-3min、第18分钟最大摄取比值UR18 min，最小排泌时间Tmin）评价唾液腺功能受损情况，对照组8例。功能受损程度不同组与对照组间各功能参数的比较采用方差分析；并依据抗SSA/SSB抗体、抗ANA抗体、抗ds-DNA抗体和RF（类风湿因子）是否阳性，比较唾液腺功能受损情况。结果（1）SGS显示唾液腺功能受损为82%（18/22），左右侧腮腺或颌下腺基本同步受损；功能正常为18%（4/22）。功能重度受损组与其他组间UR1-3 min、UR18 min均有统计学差异；功能正常组、中度受损组与对照组间UR18 min有统计学差异；功能正常组与对照组Tmin无统计学差异,功能中及重度受损组无或极少量排泌。（2）抗ds-DNA抗体均阴性，抗SSA/SSB抗体、抗ANA抗体及RF阳性分别为8、10和8例，抗SSA/SSB抗体阳性组和阴性组在唾液腺功能受损程度不同组间具有统计学差异。结论（1）SGS能敏感的发现口干患者唾液腺功能受损情况，但应将摄取和排泌功能分开评价；UR1-3 min、UR18 min和Tmin分别是评价唾液腺摄取和排泌功能不同程度受损的灵敏指标。（2）SSA/SSB自身抗体阳性者，唾液腺功能受损程度较重。