原发性干燥综合征唾液腺核素显像与唇腺活检病理的相关性分析

Correlation between functional parameters of salivary gland scintigraphy and histopathologic grading of labial biopsy in Sjgren′s syndrome

目的 客观评价原发性干燥综合征 (pSS)患者的唾液腺功能 ,筛选敏感、有意义的99mTcO-4 唾液腺显像功能参数。方法 78例 pSS和 2 0例为甲状腺结节患者为对照分别进行了99TcmO-4 唾液腺动态显像 ,所有 pSS患者于显像后进行唇腺活检 ,对显像所得功能参数与唇腺活检的病理分级进行等级相关性分析 ,对显像特点和病理关系进行了总结。结果 ①腮腺 (Par)对99mTcO-4 浓聚率 (MAR)随病理分级增大而降低 (r =- 0 6 49,P <0 0 0 1) ;酸刺激开始至刺激后放射性降低不变的时间间隔 (Tmin)随病理分级增加而延长 (r =0 32 4,P <0 0 1) ;Par的酸刺激最大分泌率 (MSR)随病理分级增加而减少 (r =- 0 5 2 1,P <0 0 0 1)。②早期分泌率 (SR)虽与病理分级无有意义的相关性 ,但在pSS早期 (病理 1～ 2级 )即可出现异常。③影像所示唾液腺功能受损程度与唇腺活检病理学改变和分级基本符合 ,总符合率为 80 8% (6 3/78)。结论 Par对99mTcO-4 的MAR降低、Tmin的延长、MSR的减少是pSS有意义的诊断指标 ,SR是 pSS非常敏感的筛检指标。99mTcO-4唾液腺显像是评价 pSS者唾液腺功能简便。

Objective To evaluate salivary gland function in primary Sjgren′s syndrome (pSS) objectively,and highly sensitive and significant indicators were chosen by correlative analyses of parameters of salivary gland scintigraphy with the histopathologic grading of labial biopsy in pSS.Methods Salivary gland scintigraphy was preformed using 99m TcO - 4 in 78 patients with pSS and 20 normal controls.Functional parameters of the parotid (Par) glands were calculated.The results of pSS groups were compared with normal controls.All patients with pSS underwent labial biopsy after imaging and Spearman rank correlation test was used for scintigraphy functional parameters and histopathologic grading.Results ① The maximum accumulation ratio (MAR) of Par gland significantly decreased with histopathologic grading increase ( r = -0 649, P <0 01).The time interval from stimulation to minimum and stable count (Tmin) of Par gland significantly increased with the histopathologic grading decreased ( r =0 324, P <0 01).The maximum secretion ratio (MSR) of Par gland decreased significantly with the histopatholgic grading increased ( r =0 521, P <0 001).② The early secretion ratio (SR) of Par gland decreased in early pSS (histopathologic grads 1 and 2),although it was not correlated significantly with hislopathologic grading.③ The involvement degree of salivary gland function in imaging was approximate coincidence in pathologic change of labial biopsy,and the total coincidence ratio was 80 8%.Conclusion These data indicate that MAR,Tmin and MSR are significant indicators,and SR is a highly sensitive indicator.Salivary gland scintigraphy is an easy and noninvasive method for evaluating patients with pSS.