^(99m)Tc标记SPECT对胃食管反流病的诊断价值

Diagnostic Value of ^(99m)Tc-labeled SPECT for Gastroesophageal Reflux Disease

背景:在胃食管反流病(GERD)的诊断方法中,放射性核素检查与上消化道内镜检查、24 h食管pH监测、食管测压等相比,具有更符合生理情况且为非侵入性的优势。目的:探讨99mTc标记单光子发射计算机断层扫描(SPECT)对GERD的诊断价值。方法:糜烂性食管炎(EE)、非糜烂性反流病(NERD)和非心源性胸痛患者各10例纳入研究,入组患者反流性疾病问卷(RDQ)评分均>12分,质子泵抑制剂(PPI)试验阳性;10例无反流症状的志愿者作为对照组。受检者饮用99mTc标记的酸性饮料,以SPECT扫描食管区,观察胃食管连接处有无放射性出现;使用计算机按感兴趣区方法勾画胃、食管轮廓,计算反流指数。结果:EE组8例患者出现食管下端放射性,其中自发反流6例,诱发反流2例;NERD组和非心源性胸痛组相应数据分别为5例、3例、2例和6例、2例、4例。对照组均未见反流。三组研究组SPECT反流阳性率均显著高于对照组(80.0%、50.0%和60.0%对0%,P<0.05)。结论:99mTc标记SPECT对GERD具有显著诊断意义,有望作为GERD的常规检查项目在临床上开展。

Background: Of the diagnostic modalities of gastroesophageal reflux disease( GERD),radioisotopic examination is more physiological and non-invasive as compared with upper gastrointestinal endoscopy,24-hour esophageal pH monitoring and esophageal manometry. Aims: To examine the diagnostic value of99mTc-labeled single-photon emission-computed tomography( SPECT) for GERD. Methods: Ten erosive esophagitis( EE),10 nonerosive reflux disease( NERD) and 10 noncardiac chest pain patients were enrolled in this study. All of them had a high reflux disease questionnaire( RDQ) score( >12) and were positive for proton pump inhibitor( PPI) test. Ten volunteers without reflux symptoms served as controls.After the taking of99mTc-labeled acidic drinks,SPECT scan was performed in esophageal region for indentifying the radioactivity at gastroesophageal junction. Through region-of-interest,the stomach and esophagus were outlined and the GERindex was calculated. Results: Radioactivity was observed in lower esophagus in 8 patients of EE group,including 6spontaneous reflux and 2 induced reflux; in NERD group and noncardiac chest pain group,the corresponding data were 5,3,2 and 6,2,4,respectively. No reflux was observed in control group. Positivity rates of reflux identified by SPECT in EE,NERD and noncardiac chest pain groups were all significantly higher than that in control group( 80. 0%,50. 0% and 60. 0%vs. 0%,P < 0. 05). Conclusions:99mTc-labeled SPECT has clinical value for diagnosis of GERD and is potential for being used as a method of GERD examination in clinical practice.