^(18)F-FDG PET-CT对有气管粘膜病变的肺结节病的评价作用

Evaluation of bronchial mucosa involvement in sarcoidosis patients using ^(18)F-FDG PET-CT

目的了解18F-FDG PET-CT检查对气管粘膜受累的结节病活动性的评价作用。方法回顾分析结节病气管粘膜受累的患者6例和粘膜未受累的患者14例的临床资料,对18F-FDG PET-CT检查肺部病灶、肺门、纵隔淋巴结的标准摄取率(SUV)最大值、平均值和血清血管紧张素转换酶、肺泡灌洗液(BALF)中CD4+与CD8+比值、淋巴细胞比例进行对比分析。结果气管腔内有粘膜改变组肺部病灶的SUV最大值/SUV平均值均高于粘膜无改变组(7.04±5.83/5.00±4.69 vs 5.68±3.66/3.82±2.39),但无统计学差异(P=0.565/0.495);气管腔内有粘膜改变组肺门、纵隔淋巴结的SUV最大值/SUV平均值均明显高于粘膜无改变组(13.28±5.57/10.48±4.43 vs 6.20±1.77/4.52±1.43;13.84±4.35/9.69±2.74 vs 7.16±2.52/5.28±1.77),有统计学差异(P=0.0003/0.0002;P=0.0004/0.0004)。气管腔内有粘膜改变组血清血管紧张素转换酶水平和BALF中CD4+/CD8+比例分别高于粘膜无改变组(60.58±16.3 IU/Lvs 49.16±13.3 IU/L;7.30±5.0 vs 2.90±3.1),两者比较均有统计学意义(P=0.045;0.026)。BALF中检测淋巴细胞比例,粘膜改变组虽高于粘膜无改变组[(44.10±10.3)%vs(35.30±12.5%)],但无统计学意义(P=0.148)。结论气管粘膜受累是活动性结节病的表现之一,18F-FDG PET-CT检查为评价支气管粘膜受累结节病的活动性提供了一定的帮助。

Objective To explore the value of ^18F- FDG PET- CT in evaluating bronchial mucosa involvement in patients with saroidosis. Methods A retrospective analysis was conducted among 6 sarcoidosis patients with and 14 patients without bronchial mucosa involvement to collect the data including the standard uptake value（SUVMax/Mean） of ^18F- FDG, serum angiotensin converting enzyme（sACE）, and proportion of lymphocytes and CD4^＋/CD8^＋T lymphocyte ratio in bronchoalveolar lavage fluid（BALF）. Results The lung focal SUV（Max/Mean）was higher in patients with bronchial mucosa involvement than those without（7.04±5.83/5.00±4.69 vs 5.68±3.66/3.82±2.39）, but such differences were not statistically significant（P=0.565/0.495）. The SUV（Max/Mean）of the hilum of the lung and the mediastina lymph nodes were significantly higher in patients with bronchial mucosa involvement（13.28±5.57/10.48±4.43 vs 6.20±1.77/4.52±1.43, P=0.0003/0.0002; 13.84±4.35/9.69±2.74 vs 7.16±2.52/5.28±1.77,P=0.0004/0.0004）. The level of sACE and CD4^＋/CD8^＋T lymphocyte ratio in BALF were also significantly higher in patients with bronchial mucosa involvement（60.58±16.3 vs 49.16±13.3 IU/L, P=0.045; 7.30±5.0 vs 2.90±3.1, P=0.026）. The proportion of lymphocytes in BALF was comparable between the patients with and without bronchial mucosa involvement（44.10±10.3% vs35.30 ± 12.5%, P=0.148）. Conclusions For patients with saroidosis,^18F- FDG PET- CT is useful in evaluating bronchial mucosa involvement, which is one of the key features of active sarcoidosis.