肥大性肺性骨关节病的骨显像特征及临床意义

Bone scan characteric findings for hypertrophic pulmonary osteoarthropathy (HPO) in patients with pulmonary diseases

目的:探讨肥大性肺性骨关节病(HPO)核素骨显像的特征、其与肺部疾病的关系及临床意义。方法:回顾性分析上海市胸科医院11025例99mTc-亚甲基二膦酸盐核素骨显像中诊断的75例HPO。结果:①75例HPO呈“双条”征和对称性关节周围放射性浓集两种表现,发生率为96%和2.6%,下肢骨“双条”征明显多于上肢骨。②HPO好发于45岁以上、吸烟史≥400年支的男性。③75例HPO有骨关节痛和杵状指症状者占33.3%,可作为胸部肿瘤主要是肺癌的首发症状。④75例HPO中96%继发于胸腔内肿瘤包括局限性胸膜肿瘤、转移性肺癌、恶性胸腺瘤和支气管肺癌,其中90.7%继发于肺癌;肺部炎症性疾病伴随HPO少见,仅占4%,分别是细菌性肺炎和浸润性肺结核。⑤肺癌HPO的发生率为2.3%,好发于周围型肺癌,病理类型以腺癌为主,分化程度91.2%为中/低分化,与分期无关。结论:HPO以“双条”征为主要显像特征,常提示肺部疾病的发生,主要与胸部肿瘤特别是肺癌有密切关系,临床应予重视。

Purpose： To investigate the charateristic findings for HPO in bone seintigraphy and evaluate the clincal significance of HPO in lung diseases.Methods：^99mTc-MDP bone scintigram of 11024 patients in Shanghai Chest Hospital were reviewed.Among them 75 HPO eases were confirmed by ^99mTc-MDP bone scan.The scintigrams and clinical evidences of these patients were retrospectively analyzed.Results：①In our study,bone scan dislosed two patterns：doublestripe sign and symmetrically increased uptake in juxta-articuar bone.The incidence werer 96% and 2.6% respectively.Inereased uptake along the cortical margins of the long bone were more obvious in the lower than upper extremities.②HOP occurred principally in man more than 45 years old with smoking history exceeding 00 pack years.③Digital clubbing and arthralgia wrer presented in 25（33.3%）of the 75 patients with HPO. They may be the first sign of the intrathoracie tumors especially of bronchogenic careinoma.④We observed 72 HPO cases（96%）secondary to intrathoracic tumors including solitary pleural tumor,pulmonary metastatic tumor,thymic carcinoma and bronchogenic carcinoma.The most common disease associated with HPO was bronchogenic carcinoma.which occurred in 90.7% of patients.The inflammatory pulmonary disease associated with HPO was bronchogenic carcinoma,which occurred in 90.7%of patients.The inflammatory pulmonary disease associated with HPO was unusual（4%）,including bacterial pneumonia and tubelosis.⑤The incidence of HPO in patients with bronchogenic eareinoma was 2.3%.The tumor was predominantly located in the periphery.HPO was more common in patients with adenocarcinoma（51.4%）and almost occurred in middle or low differentiated lung cancer（91.2%）,There was no relationship between HPO and staging of tumor.Conclusions：Double-stripe sign was a main characteristic finding for HPO.The presence of HPO may predict the involvement of lung disease.HPO wa mainly associated with intrathoracic tumors especially with lung cancer.The physicians should pay much attention to the syndrome.