继发性噬血细胞综合征的^(18)F-FDG PET/CT特征及临床征象分析

^(18)F-FDG PET/CT features and clinical indicators of secondary hemophagocytic syndrome

目的:探讨继发性噬血细胞综合征(HPS)的^(18)F-FDG PET/CT特征及其与临床的相关性。方法:回顾性分析37例经临床诊断的继发性HPS患者的^(18)F-FDG PET/CT检查图像资料及临床资料,计算PET参数(脾脏、骨髓SUVmax值以及脾脏/纵隔、骨髓/纵隔、脾脏/肝脏、骨髓/肝脏的SUVmax比值)与各实验室参数(血红蛋白、中性粒细胞绝对值和血小板计数、甘油三酯、纤维蛋白原、乳酸脱氢酶、谷丙转氨酶、C-反应蛋白、血清铁蛋白)的相关性。按照继发于肿瘤与非继发于肿瘤(感染、风湿免疫类疾病),所有患者分为两组,计算PET/CT对于肿瘤相关性HPS的诊断敏感度、特异度及符合率,分别计算各组内PET参数与实验室参数的相关性。同时采用成组资料t检验比较两组患者的PET参数与实验室参数的差异。结果:所有患者的相关性分析结果显示,中性粒细胞绝对值及C-反应蛋白与脾脏SUVmax呈正相关(r=0.332、0.351,P<0.05),红细胞值与骨髓SUVmax呈负相关(r=-0.349,P<0.05),中性粒细胞绝对值还与脾脏/纵隔的SUVmax比值呈正相关(r=0.448,P<0.05),另外红细胞及血红蛋白值与骨髓/肝脏的SUVmax比值呈负相关(r=-0.556、-0.438,P<0.05)。PET/CT对于肿瘤相关性HPS的诊断敏感度为90.00%,特异度为61.54%,符合率为78.79%。继发于恶性肿瘤的HPS患者,中性粒细胞绝对值分别与脾脏SUVmax及脾脏/肝脏SUVmax比值呈正相关(r=0.511、0.462,P<0.05),C-反应蛋白分别与脾脏SUVmax及脾脏/纵隔SUVmax比值呈正相关(r=0.548、0.618,P<0.05),两组患者的红细胞与骨髓/肝脏SUVmax比值均呈负相关(r=-0.514、-0.670,P<0.050),两组患者的淋巴结SUVmax、骨髓/纵隔的SUVmax比值差异具有统计学意义(t=2.683、2.306,P<0.05)。结论:^(18)F-FDG PET-CT对于继发性HPS的诊断及原发病因的鉴别、判断病情严重程度具有一定临床价值。

Objective:To investigate the ^(18)F-FDG PET/CT characteristics of the secondary hemophagocytic syndrome(HPS)and its clinical relevance.Methods:The ^(18)F-FDG PET/CT imaging data and clinical data of 37 patients with secondary HPS were retrospectively analyzed.The correlation between PET parameters(SUVmax of the spleen,bone marrow,SUVmax ratios of spleen/mediastinum,bone marrow/mediastinum,spleen/liver,bone marrow/liver)and laboratory parameters(hemoglobin,neutrophils and platelet count,triglyceride,fibrinogen,lactate dehydrogenase,alanine aminotransferase,C-reactive protein,serum ferritin)was calculated.According to the secondary tumor and non-secondary tumor(infection,rheumatic immune diseases),all patients were divided into two groups.The diagnostic sensitivity,specificity,and accuracy of PET/CT for tumor-related HPS were calculated,and the correlation between PET parameters and laboratory parameters in each group was calculated.At the same time,a group data t-test was used to compare the differences between PET parameters(including SUVmax of lymph nodes)and laboratory parameters between the two groups.Results:Correlation analysis showed that neutrophils and C-reactive protein were positively correlated with SUVmax of spleen(r=0.332,0.351,respectively,P<0.05).In addition,erythrocyte count and SUVmax of bone marrow were negatively correlated(r=-0.349,P<0.05),neutrophils were positively correlated with SUVmax ratio of spleen/mediastinum(r=0.448,P<0.05),and erythrocyte count and hemoglobin to SUVmax ratio of bone marrow/liver were negatively correlated(r=-0.556,-0.438,P<0.05),and there was no correlation between other PET parameters and laboratory parameters.The diagnostic sensitivity,specificity,and accuracy of PET/CT for tumor-associated HPS were 90.00%,61.54%,and 78.79%,respectively.In HPS patients secondary to malignant tumor,neutrophils were positively correlated with spleen SUVmax and spleen/liver SUVmax ratios(r=0.511,0.462,P<0.05).C-reactive protein was positively correlated with spleen SUVmax and spleen/mediastinal SUVmax ratios(r=0.548,0.618,respectively,P<0.05).Erythrocyte count and SUVmax ratio of bone marrow/liver were negatively correlated in both groups(r=-0.514,-0.670,respectively,P<0.050).The SUVmax of lymph nodes and SUVmax ratios of bone marrow/mediastinum between the two groups was compared,and the difference was statistically significant(P<0.05).Conclusion:^(18)F-FDG PET/CT has a certain clinical value for diagnosing secondary HPS,identifying primary causes,and judging the severity of the disease.