原发性肺癌^(99m)Tc-MIBI显像与多药耐药蛋白表达的关系

The Studies on Relationship between ^(99m)Tc-MIBI Scintigraphy of Primary Lung Cancer and Expression of Multidrug-resistant Protein

目的:探讨原发性肺癌对99mTc-MIBI摄取和滞留与三种多药耐药蛋白表达的关系及临床意义。方法:对26例原发性肺癌患者静脉注射925MBq99mTc-MIBI后15min和120min分别行SPECT显像,采用感性趣区(ROI)技术计算早期和延迟相肿瘤/非肿瘤(T/N)比值以及滞留率RI%。采用免疫组化法检测肺癌组织多药耐药蛋白P-gp、MRP和GSTπ表达水平,并与T/N和RI%进行相关性分析。结果:99mTc-MIBI显像阳性率为92.31%;P-gp、MRP、GSTπ表达阳性率分别为75.00%、58.33%、45.83%,三者无明显差别("2=4.273,P=0.118)。P-gp+MRP、P-gp+GSTπ、MRP+GSTπ、P-gp+MRP+GSTπ共表达阳性率分别为41.67%、37.50%、29.17%、20.83%;P-gp表达阳性组和阴性组RI%间有显著性差异(t=-2.258,P=0.034)。结论:99mTc-MIBI显像能预测肺癌组织P-gp的表达水平,为临床个体化治疗提供理论依据。

Objective： To investigate the relationship between the degree of ^99mTc-methoxyisobutylisonitrile （MIBI） uptake and the expression of muhidrug-resistant protein P-gp, MRP and GSTπ in patients with primary lung cancer. Methods： Twenty-six patients with untreated primary lung cancer were studied prospectively. After i.v. administration of 925 MBq ^99mTc-MIBI, planar and SPECT imaging at 15 minutes and 120 minutes were performed. By means of semiquantitative method, Tc/ N, Td/N （tumor-to-normal lung ratio in early and delay image respectively） and RI% （retention indices） were calculated, lmmunohistochemical analysis was used to evaluate the expression of Pgp, MRP and GSTπ. Results： The positive rate of ^99mTc-MIBI in the patients with primary lung cancer was 92.31% and the mean value of Tc/ N, Td/ N and RI% were 1.71±0.44, 1.76±0.41 and 4.58±14.19 respectively. The positive expression rates of P-gp, MRP and GSTπ were 75.00%, 58.33% and 45.83%. There was no significant difference among them （x^2=4.273,P=0. 118）. The positive co-expression rates of P-gp＋MRP, P- gp＋GSTπ, MRP＋GSTπ and P-gp＋MRP ＋GSTπ were 41.67%, 37.50%,29.17% and 20.83%. The RI% of P-gp positive group was significant lower than that of negative group （t=-2.258, P=0.034）. Conclusion： The study suggests that ^99mTc-MIBI scintigraphy may predict the MDR development associated with P-gp expression in lung cancer, which can offer theoretical basis for individual therapy.