99mTc-MIBI对尿毒症继发性甲旁亢的测定及意义

99mTc-MIBI Imaging of Secondary Hyperparathyroidism in Uremia and Its Significance

目的了解 99mTc -甲氧基异丁基异晴 (MIBI)扫描对尿毒症伴继发性甲旁亢者甲状旁腺病灶的诊断价值及治疗的指导意义。 方法 16例尿毒症维持性血透患者根据血iPTH水平 ,分为正常组 3例、升高组 3例、显著升高组 10例。静脉注射 370～ 5 5 0mBq 99mTc -MIBI后 10～ 15min进行初始相采集 ,2～ 4h进行延迟相采集 ,观察甲状旁腺病灶 ,并与B超相比较。 结果正常组无 1例发现甲状旁腺病灶 ;升高组 1例发现甲状旁腺腺瘤 ;显著升高组有 5例发现甲状旁腺腺瘤 ,对 1,2 5 (OH) 2 D3 治疗反应差。而前 1例仅有iPTH明显升高 ,但同位素扫描无腺瘤 ,故治疗效果好。 结论 99mTc -MIBI双时相法对于甲状旁腺腺瘤的定位诊断优于B超 ,其检测阳性率与血iPTH的水平升高相一致 ,由此对指导 1,2 5 (OH) 2 D3 冲击治疗有一定意义。

Objective To evaluate 99mTc-MIBI in the localization of hyperfunctioning parathyroid tissues in uremia and guide therapy. Methods Sixteen patients underwent double phase 99mTc-MIBI imaging. According to serum iPTH levels, they were devided into 3 groups: normal iPTH?3 patients, high iPTH 3 patients, very high iPTH 10 patients. Results One adenoma was found in the high iPTH group and 5 adenomas were found in the very high iPTH group. The last group of patients with adenomas had poor reaction to 1,25(OH) 2D 3 treatment. Conclusion Double phase 99mTc-MIBI imaging is a promising technique for localization of parathyroid adenomas. Its high incidence is consistent with the high iPTH level. It is necessary for patients to undergo noninvasive imaging procedures before they receive 1,25(OH) 2D 3 treatment.