18F-FDG PET/CT在多发性肌炎/皮肌炎患者诊断及病情评估中的临床应用

Clinical application of F-FDG PET/CT in the diagnosis and severity evaluation of polymyositis/dermatomyositis

目的探讨18氟-氟代脱氧葡萄糖正电子发射计算机断层显像(18F-FDG PET/CT)对多发性肌炎/皮肌炎(PM/DM)的诊断价值及其对疾病活动度的评价作用。方法采用回顾性研究方法,选取2017年12月至2019年12月首都医科大学附属北京友谊医院收治的接受18F-FDG PET/CT检查的PM/DM患者13例,其中PM5例,DM8例,合并肿瘤3例(肺癌2例,鼻咽癌1例),有肺间质病变6例。同时收集年龄和性别匹配的健康体检者13例,记录并比较患者及健康人7个区域近端肢带肌群(肩背部肌肉、肱二头肌、颈椎旁肌肉、胸椎旁肌肉、腰椎旁肌肉、臀部肌肉、股四头肌)的标准化摄取值(SUV),采用两样本t检验、χ^2检验,相关性分析采用Pearson分析方法处理数据。结果 PM患者肌肉SUV为(1.83±0.45) g/ml,DM患者肌肉SUV为(2.39±1.98) g/ml,均高于健康体检者(1.07±0.23) g/ml,差异具有统计学意义(P<0.001)。相关性分析显示,PM/DM患者肌肉SUV与肌酸激酶(CK)(r=0.600,P<0.05)、乳酸脱氢酶(LDH)(r=0.855,P<0.01)、α-羟丁酸脱氢酶(HBDH)(r=0.834,P<0.01)、疾病活动度(r=0.723,P<0.05)均呈正相关。ROC曲线分析显示,肌肉SUV最佳临界值为1.393 g/ml,诊断PM/DM的灵敏度为84.6%,特异度为92.3%,ROC曲线下面积为0.895(95%CI:0.824~0.966)。结论18F-FDG PET/CT测定的近端肢带肌群SUV值对PM/DM具有诊断价值,肌肉SUV值与肌力、肌酸激酶水平、疾病活动度具有相关性,可反映疾病活动度。18F-FDG PET/CT可以作为评估PM/DM病情活动度的工具之一。

Objective To study the diagnostic value of18F-Fluorodeoxyglucose Positron emission Tomography/Computed Tomography(18F-FDG PET/CT) in polymyositis(PM)/dermatomyositis(DM) and its evaluation of disease activity.Methods 13 PM/DM patients who underwent18F-FDG PET/CT in Beijing Friendship Hospital,Capital Medical University from December 2017 to December 2019 were retrospectively selected,including 5 patients with PM,8 patients with DM.There were 3 patients associated with tumor(2 patients with lung cancer,1 patient with nasopharyngeal carcinoma),6 patients associated with interstitial lung diseases.Simultaneously,13 healthy volunteers with age and gender matching were collected.Standardized uptake values(SUV) of the 7 proximal limb muscles(shoulder and back muscles,biceps,para-cervical muscles,para-thoracic muscles,para-lumbar muscles,gluteal muscles,quadriceps) were recorded and compared in patients and healthy volunteers.Two-sample t-test and χ^2 test were used for analyzing data,and Pearson analysis was used for correlation analysis.Results The muscle SUV of PM,DM patients were(1.83 ± 0.45) g/ml,(2.39 ± 1.98) g/ml,respectively.Both were significantly higher than that of healthy volunteers(1.07 ± 0.23) g/ml(P< 0.001).The muscle SUV of PM/DM was positively correlated with serum levels of creatine kinase(CK)(r =0.600,P<0.05),lactate dehydrogenase(LDH)(r =0.855,P<0.01),alpha-hydroxybutyric dehydrogenase(HBDH)(r =0.834,P< 0.01) and disease activity(r = 0.723,P< 0.05).ROC curve showed the optimal SUV cutoff point was 1.393 g/ml,with the sensitivity of84.6% and the specificity of 92.3%.The area under curve was 0.895(95% CI: 0.824 ~ 0.966).Conclusion The SUV of proximal limb muscles measured by18F-FDG PET/CT has diagnostic value for PM/DM.The muscle SUV is correlated with muscle strength,creatine kinase level and disease activity,which can reflect disease activity.18F-FDG PET/CT can be used as a tool to evaluate the activity of PM/DM.