原发性肝癌骨转移核素显像与中医辨证分型的比较分析

Analysis of Nuclear Skeletal Imaging of Primary Liver Cancer Patients with Bone Metastasis and Exploration of Its Syndrome Patterns

目的:探讨原发性肝癌骨转移单光子发射型计算机扫描(SPECT)显像图像表现特点及其中医辨证分型的构成情况。方法:选取2003年7月～2007年4月我院收治的原发性肝癌伴骨转移患者43例,对其X线平片、计算机扫描(CT)或核磁共振(MR)检查、放射性核素骨显像等资料进行汇总,分析其全身骨骼的骨转移分布特点和中医辨证分型的构成情况。结果:原发性肝癌骨转移43例中气滞血瘀型21例,肝郁脾虚型14例,肝肾阴虚型5例,湿瘀互结型2例,湿热蕴结型1例;病变范围分布依次为椎骨23例、颅骨18例、骨盆(髂骨、耻骨、坐骨、骶髂关节)12例、肋骨11例、四肢长骨近端7例和胸骨2例。放射性分布主要为溶骨性骨转移的稀疏和缺损分布,周边呈轻度或中度放射性浓聚,在颅骨和骨盆处呈明显炸面圈状,部分位于骨盆、四肢长骨近端病灶为放射性稀疏和缺损分布,周边无浓聚表现。结论:原发性肝癌骨转移以气滞血瘀型多见,肝郁脾虚型次之,其他症型骨转移比例较少;骨转移主要为扁平骨多见的溶骨性病灶。

Objective:To analyze the nuclear skeletal imaging of primary liver can- cer patients with bone metastasis,and to explore the distribution of its syndrome patterns. Methods:Forty-three primary liver cancer patients with bone metastasis,which were admitted from July,2003 to April,2007 in the Second Affiliated Hospital of Guangzbou University of TCM,were enrolled into this study. The imaging data such as X-ray plain film,computerized tomography scanning,nuclear magnetic resonance,and radionuclide bone imaging were collected to analyze the feuatures of bone metastaisis of primary liver cancer patients. Meanwhile,the the distribution of its syndrome patterns was also ex- plored. Results:Of 43 primary liver cancer patients with bone metastasis,21 were clas- sified into the syndrome of Qi stagnation and blood stasis,14 into liver stagnation and spleen deficiency,5 into deficiency of liver and kidney yin,2 into congelation of damp with stasis,and one into stagnation of damp-heat. The bone metastasis involved verte- brae(n=23),skull(n=18),pelvis(n=12),rib(n=11),proximal end of long bone of extremities(n=7),and sternum(n=2). Radioactive changes were due to the loss and sparsity of bone in osteolytic metastasis which was mainly located in pelvis, proximal end of long bone of extremities. The doughnut-like distribution of bone metas- tasis was mainly located in skull and pelvis. Conclusion:Primary liver cancer patients with bone metastasis can be differentiated mainly as Qi stagnation and blood stasis,anti then as liver stagnation and spleen deficiency. The other syndrome patterns are less found. Bone metastasis is mainly characterized by osteolytic metastasis in the fiat bones.