2型糖尿病患者氟-18标记脱氧葡萄糖心肌代谢显像图像质量与相关代谢因素的分析

Study on the relationship between the metabolic factors and the quality of ^18 F-fluorode oxyglucose myocardial metabolic imaging in patients with type 2 diabetes

目的探讨2型糖尿病患者氟-18标记脱氧葡萄糖（^18 F-FDG）心肌代谢显像图像质量与相关代谢因素的关系。方法70例年龄≥60岁的2型糖尿病并存冠心病患者，行^18 F-FDG心肌代谢显像。并于显像当日测定血糖、糖化血红蛋白（HbAlc）、胰岛素和C肽、总胆固醇、三酰甘油、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇等指标，计算HOMA胰岛素抵抗指数和HOMA胰岛β细胞功能指数。图像质量评定采用评分法。结果与图像质量不佳组（36例）比较，图像质量良好组（34例）的患者年龄较小，分别为（62．2±8．5）岁和（67．6±8．3）岁（P〈0．01）；体质指数（body mass index，BMI）较小，分别为（24．7±2．6）kg／m^2和（26．1±2．5）kg／m^2（P〈0．05）；空腹胰岛素和C肽水平明显降低，分别为8．3（5．1～12．4）mIu／L和12．2（6．1～17．9）mIu／L（P〈0．05）、0．6（0．5～0．9）nmol／L和0．9（0．6～1．2）nmol／L（P〈O．05）。图像质量好组HOMA胰岛素抵抗指数低于图像质量不佳组，分别为2．7（1．6～4．0）和4．1（1．7～6．5）（P〈0．05）。Logistic回归分析显示，肥胖是图像质量不佳的独立因素，校正其它代谢指标后的OR值为3．73（95％CI为1．12～12．45，P〈0．05）。年龄也是影响图像质量的危险因素，大于65岁的OR值为4．64（95％CI，1．46～14．7，P〈0．05），校正BMI等因素后OR值为3．75（95％CI，0．96～14．6，P〉0．05）结论影响2型糖尿病患者^18 FFDG心肌代谢显像图像质量的主要代谢因素是胰岛素抵抗，此外年龄、肥胖也是影响图像质量的重要因素。

Objective To evaluate the effects of metabolic factors on the quality of ^18 F-fluorode oxyglucose （^18 F-FDG） myocardial metabolic imaging in coronary artery disease （CAD） patients with type 2 diabetes mellitus （T2DM）. Methods Seventy CAD patients aged 60 years or over with T2DM were studied with myocardial ^18F-FDG dual isotope simultaneous acquisition （DISA） single photon emission computed tomography （SPECT）. Fasting plasma glucose, total triglyceride（TG）, total cholesterol （ TC）, high density lipoprotein-cholesterol （ HDL-C）, low density lipoprotein- cholesterol（LDL-C）, insulin, C peptide and glycosylated hemoglobia （HbAlc） were detected. Insulin resistance and islet β cell function were calculated by using the Homeostasis Model Assessment （HOMA） equation. Results Compared with the bad image quality group （36 cases）. patients in the excellent image quality group （34 cases） were younger [with average age of （62.2±8.5） years vs. （67.6±8.3） years, P〈0.01] and slimmer [with BMI of （24.7±2.6）kg/m^2 vs. （26.1±2.5）kg/ m^2 , P〈0.05]. The levels of fasting insulin and C peptide were lower in the excellent image quality group than those in the bad image quality group [with fasting insulin level of 8.3 （5.1-12.4） mIu/L vs. 12.2（6.1-17.9）mIu/Land C peptidelevelof 0.6（0.5-0.9）nmol/L vs. 0.9（0.6-1.2）nmol/ L, respectively,both P〈0.05]. The HOMA insulin resistant index was reduced in the excellent image group [2.7（1.6-4.0） vs. 4.1（1.7-6.5）, P〈0.05]. Logistic regression analysis showed that obesity and age≥65 years were independent risk factors for image quality, with OR value of 3.73 （95% CI： 1.12-12.45,P=0. 022）and 3.75 （95GCI：0.96-14.6,P=0. 058）after adjustment of other metabolic factors. Conclusions Insulin resistance is the main factor that influences the quality of ^18F-FDG myocardial metabolic imaging in patients with T2DM. In addition, age≥65 years and obesity are also risk factors for image quality.