肺癌骨转移患者SPECT/CT最大标准化摄取值及血清ALP N-MID TPINP水平及意义分析

doi:10.3969/j.issn.1006-6233.2023.05.022

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摘要 目的:探讨肺癌骨转移患者单光子发射计算机断层成扫描(SPECT)/计算机断层成扫描(CT)最大标准化摄取值(SUVmax)及血清碱性磷酸酶(ALP)、骨钙素N端中分子片段(N-MID)、总Ⅰ型前胶原氨基端前肽(TPINP)水平及意义。方法:选取2021年1月至2022年6月在我院治疗的肺癌患者107例,其中合并骨转移患者37例,无骨转移患者70例,比较合并骨转移和无骨转移患者SUVmax、ALP、N-MID及TPINP差异,同时分析SUVmax、ALP、N-MID及TPINP与临床病理特征的关系,以及ALP、N-MID及TPINP诊断骨转移的价值。结果:骨转移患者ALP、N-MID和TPINP分别为(120.30±33.32)U/L、(19.03±3.54)mg/L和(82.21±26.65)mg/L,明显高于无骨转移患者(P<0.05),而腰椎骨密度(BMD)为(0.82±0.12),明显低于无骨转移患者(P<0.05)。腺癌患者SUVmax为(11.45±1.98),明显低于鳞癌和其他类型患者(P<0.05);肿瘤直径>5cm、TNM分期Ⅲ~Ⅳ期SUVmax分别为(13.38±1.95)和(12.99±2.00),明显高于肿瘤直径≤5cm、TNM分期Ⅰ~Ⅱ期患者(P<0.05)。TNM分期Ⅲ~Ⅳ期ALP、N-MID和TPINP分别为(110.39±21.12)U/L、(18.62±2.22)mg/L和(70.31±17.02)mg/L,明显高于TNM分期Ⅰ~Ⅱ期患者(P<0.05)。ALP、N-MID和TPINP诊断骨转移的ROC曲线下面积分别为0.695、0.734和0.837,P<0.05。结论:相比较无骨转移肺癌患者,肺癌骨转移患者及血清ALP、N-MID、TPINP水平明显升高,而SUVmax无明显差异;SUVmax、ALP、N-MID和TPINP与肺癌患者临床病理特征有一定关系,其中ALP、N-MID和TPINP在诊断肺癌骨转移方面有一定应用价值。

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关键词 ：肺癌, 骨转移, 单光子发生计算机断层成像术, 最大标准化摄取值, 碱性磷酸酶, 骨钙素N端中分子片段, 总Ⅰ型前胶原氨基端前肽

Abstract：Objective: To investigate the significance of the maximum standardized uptake value (SUVmax) of single photon emission computed tomography(SPECT)/computed tomography(CT), serum alkaline phosphatase (ALP), N-terminal intermediate molecular fragment of osteocalcin (N-MID), and total type I procollagen N-terminal prepreptide (TPINP) in patients with bone metastasis from lung cancer. Methods: A total of 107 lung cancer patients treated in our hospital from January 2021 to June 2022 were selected, including 37 patients with bone metastasis and 70 patients without bone metastasis, the differences of SUVmax, ALP, N-MID and TPINP between patients with bone metastasis and patients without bone metastasis were compared, and the relationship between SUVmax, ALP, N-MID and TPINP and clinicopathological characteristics was analyzed, as well as the value of ALP, N-MID and TPINP in diagnosing bone metastasis. Results: The ALP, N-MID and TPINP of patients with bone metastasis were (120.30 ± 33.32) U/L, (19.03 ± 3.54) μg/L and (82.21 ± 26.65) μg/L, respectively, which were significantly higher than those of patients without bone metastasis (P<0.05), while the lumbar bone mineral density (BMD) was (0.82 ± 0.12), (0.74 ± 0.11) and (0.66 ± 0.14), respectively, which was significantly lower than that of patients without bone metastasis (P<0.05). SUVmax in patients with adenocarcinoma was (11.45 ± 1.98), which was significantly lower than that in patients with squamous cell carcinoma and other types (P<0.05). The SUVmax of tumor diameter>5cm and TNM stage Ⅲ~Ⅳ were (13.38 ± 1.95) and (12.99 ± 2.00) respectively, which were significantly higher than those of patients with treatment diameter ≤ 5cm and TNM stage Ⅰ~Ⅱ (P<0.05). ALP, N-MID and TPINP in TNM stage Ⅲ~Ⅳ were (110.39 ± 21.12) U/L, (18.62 ± 2.22) μg/L and (70.31 ± 17.02) μg/L respectively, which were significantly higher than those in TNM stage Ⅰ~Ⅱ patients (P<0.05). The area under ROC curve of ALP, N-MID and TPINP in diagnosing bone metastasis was 0.695, 0.734 and 0.837 respectively (P<0.05). Conclusion: Compared with lung cancer patients with without bone metastasis, the levels of ALP, N-MID and TPINP in lung cancer patients with bone metastasis are significantly higher, while SUVmax has no significant difference; SUVmax, ALP, N-MID and TPINP have a certain relationship with the clinicopathological characteristics of lung cancer patients. Among them, ALP, N-MID and TPINP have a certain application value in the diagnosis of bone metastasis of lung cancer.

Key words： Lung cancer Bone metastasis Single photon generation computed tomography Maximum standardized uptake value Alkaline phosphatase N-terminal fragment of osteocalcin Total type I procollagen N-terminal propeptide

基金资助:内蒙古自治区自然科学基金项目,(编号:2017MS0816);包头市卫生健康委科技计划项目,(编号:wsjkwkj050)

通讯作者: 顾虹

引用本文:

谭国威, 于青禾, 顾虹. 肺癌骨转移患者SPECT/CT最大标准化摄取值及血清ALP N-MID TPINP水平及意义分析[J]. 河北医学, 2023, 29(5): 808-814.
TAN Guowei, et al. Maximum Standardized Uptake Value of SPECT/CT and Serum ALP N-MID TPINP Levels in Patients with Lung Cancer Bone Metastasis and Their Significance. HeBei Med, 2023, 29(5): 808-814.

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