TPINP和ICTP检测及SPECT和CT显像在乳腺癌骨转移中的应用

摘要

目的 比较血清TPINP和ICTP检测及SPECT和CT显像对乳腺癌术后骨转移的诊断价值.方法 选取2012年1月至2014年12月经手术病理确诊的乳腺癌患者252例,进行全身骨显像扫描.SPECT使用低能高分辨准直器,患者取全身前位和后位显像,并结合常规CT扫描进行分析.检测TPINP 和ICTP采用RIA药盒,计算采用log-logit或四参数数据处理模式.结果 乳腺癌术后SPECT骨转移率为19.4%(48/252),48例骨转移患者发现病灶123个;乳腺癌术后CT骨转移率为11.9%(30/252),30例骨转移患者发现病灶53个.SPECT和CT的转移率、病灶数比较差异均有统计学意义(χ2=4.914、P<0.05和χ2=41.386、P<0.01).血清TPINP和ICTP水平在SPECT阳性组明显高于SPECT阴性组,两者比较差异均有统计学意义(t=4.609、P<0.01和t=8.799,P<0.01).结论 99Tcm-MDP全身骨显像与CT显像比较对乳癌术后骨转移有有重要的临床应用价值,具有灵敏度高、早期发现、全身成像不易漏诊的优点.TPINP作为骨形成标志物、ICTP作为骨吸收标志物能在早期出现变化,对乳腺癌术后骨转移有重要的临床应用价值.全身显像与骨转换生化标志物相互补充,乃肿瘤诊断和治疗的趋势.%Objective Comparison of serum TPINP and ICTP levels and the applications of SPECT and CT imaging in the diagnosis of bone metastasis after breast cancer surgery.Methods Whole body bone imaging was performed by using Siemens Medical Solutions Inc.SymbiaE scanner and GE Brightspeed64 multi slice CT scanner.For SPECT, we uses low energy high resolution collimator, with anterior and posterior whole-body imaging, combined with conventional CT scanning analysis.Detection of TPINP and ICTP by using RIA kit.The values were calculated using log-logit or four parameter data processing mode.Results The bone metastasis rate of SPECT was 19.4% (48/252) in breast cancer patients, and the incidence was found to be the same in all the 48 patients with bone metastasis.The metastasis rate of CT was (30/252) after breast cancer surgery, and the incidence of bone metastasis in patients with breast cancer was 53.Comparing the SPECT and CT transfer rate, the number of lesions were statistically significant(χ2=4.914,P<0.05 and χ2=41.386,P<0.01.The levels of serum TPINP and ICTP in SPECT positive group were significantly higher than those in SPECT negative group, (t=4.609, P<0.01 and t=8.799, P<0.01).Conclusion 99Tcm-MDP bone imaging and CT imaging of bone metastasis after breast cancer has important clinical application values.It has the advantages of high sensitivity, high early discovery rate, low missing rate for systemic imaging.TPINP, as a marker of bone formation and ICTP as a marker of bone resorption, can change in the early stage, and has important clinical values in the postoperative bone metastasis of breast cancer.Whole body imaging and biochemical markers of bone turnover can complement each other, which represent the trend of tumor diagnosis and treatment.