骨显像联合血清骨型碱性磷酸酶诊断恶性肿瘤骨转移

Diagnosis of osseous metastases of malignant tumors by bone scanning combined with bone alkaline phosphatase detection

目的 探讨骨型碱性磷酸酶(B-AKP)对恶性肿瘤骨转移的诊断价值。方法 对106例恶性肿瘤患者(分为骨转移组和无骨转移组)进行骨显像并测定B-AKP水平。对患者和正常对照、骨转移组和无骨转移组、骨显像不同级别者的B-AKP水平进行比较,并对B-AKP值与骨病灶数目进行相关分析。结果 (1)106例患者中,骨转移者68例、无骨转移者38例,转移率64.2％;(2)骨转移组B-AKP水平(28.4±14.8μg/l)与无骨转移组(12.8±7.6μg/l)差异显著(t=6.056,P<0.001)。骨显像0～3级各组B-AKP分别为13.9±6.8、17.2±9.4、23.8±10.4和49.5±17.μg/L,除0级与1级组、1级组与2级组之间B-AKP值无差异外(P>0.05),其它各组间差异显著(P<0.05);(3)6例单发热区患者B-AKP值(19.6±4.2μg/l)与4例单发冷区患者(13.1±3.4μg/l)差异显著(P<0.05);(4)B-AKP值与骨转移病灶数目之间相关系数r=0.751,P<0.01。结论 B-AKP与骨显像有很好的一致性。诊断恶性肿瘤骨转移,应首选骨显像。对于单发热区病灶,应结合B-AKP检测以防漏诊;对于疑似假阳性病灶,结合B-AKP值作出相应诊断,以免误诊。

objective To assess the diagnostic value of bone alkaline phosphatase (B-AKP) detection in diagnosis of osseous metastases of malignant tumors. Methods Bone scanning and B-AKP detection were performed in 106 patients with malignancies. According to the findings in bone imaging and clinical symptoms, the patients were divided into bone metastases group (BM) and non-bone metastases group (NBM), between whom B-AKP was compared by t test. According to the number of osseous lesions on bone imaging, the patients were graded and B-AKP was compared between the 4 grades. Correlation analysis was performed between B-AKP level and the number of osseous lesions. Results Among the 106 patients, bone scanning found osseous metastases in 68 patients. For diagnosing osseous metastases, the sensitivity, specificity, PPV and NPV of B-AKP detection were 89.7%, 52.6%' 77.2% and 74.0%, respectively. B-AKP was 28.4±14.8 μg/L in BM group and 12.8±7.6 μg/L in NBM group, showing significant difference (t=6.056, P<0.001). B-AKP was 13.9±6.8 μg/L, 17.2±9.4 μg/L, 23.8±10.4 μg/L and 49.5±17.6 μg/L in patients of grade 0, 1, 2, and 3, respectively, showing significant difference by comparisons between the grades (P<0.05) except for that between grades 0 and 1 (t=1.320, P>05) and between grades 1 and 2 (t=1. 803, P>0.05). B-AKP was 19.6±4.2 μg/L in patients with single hot focus and 13.1±3.4 μg/L in patients with single cold focus (t=2.570, P<0.05). Correlation analysis showed that there was low-degree correlation between B-AKP level and the number of osseous lesions (r=0.751, P<0.01). Conclusions B-AKP level detection and bone imaging yield consistent results. For diagnosis of osseous metastases in patients with malignant tumor, bone scanning is the primary choice but in cases of single hot lesions, B-AKP should be performed to prevent missed diagnosis; for false positive lesions, B-AKP should also be detected to prevent misdiagnosis.