99mTc-奥曲肽SPECT/CT对活动期甲状腺相关性眼病治疗的效果评价

眼科 ›› 2013, Vol. 22 ›› Issue (5): 309-312.

^99mTc-奥曲肽SPECT/CT对活动期甲状腺相关性眼病治疗的效果评价

罗莎, 王雪, 刘黎洁, 李眉

100730 首都医科大学附属北京同仁医院核医学科（罗莎、刘黎洁、李眉）；内分泌科（王雪）

收稿日期:2013-08-19 出版日期:2013-09-25 发布日期:2013-09-29
通讯作者: 李眉，Email: lee_mei_bj@msn.com
基金资助:
首都临床特色应用研究专项基金（2131107 002213111）

The evaluation of treatment effect of active thyroid associated ophthalmopathy with ^99mTc labeled octreotide SPECT/CT

LUO Sha¹, WANG Xue², LIU Li-Jie¹, LI Mei¹

1. Department of Nuclear Medicine, 2. Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China

Received:2013-08-19 Online:2013-09-25 Published:2013-09-29
Contact: LI Mei, Email: lee_mei_bj@msn.com

摘要/Abstract

摘要： 目的探讨99mTc-奥曲肽眼眶SPECT/CT显像对活动期甲状腺相关性眼病（TAO）治疗效果评价的价值。设计回顾性病例系列。研究对象 21例活动期TAO患者，37眼受累，5眼未受累。方法对活动期TAO治疗前后分别行99mTc-奥曲肽眼眶SPECT/CT显像及临床活动性评分（CAS），以评价治疗效果。主要指标 眼眶与枕部颅骨的示踪剂摄取比值（O/OCC）、受累眼外肌组数（N）、临床活动性评分CAS。结果治疗前受累眼肌数N为（2.70±1.00）条，CAS为（5.49±2.04）。治疗前受累眼的O/OCC为（2.00±0.35），高于未受累眼的（1.14±0.10），差异有统计学意义（P=0.000）。治疗后受累眼O/OCC为（1.38±0.30）、CAS为（1.78±1.18）、N为（1.16±0.93），均低于治疗前（P均=0.000）。而未受累眼治疗后O/OCC为（1.03±0.07），与治疗前比较无统计学差异（P=0.242）。治疗前O/OCC、N与治疗前CAS有中度相关性（r=0.574，P<0.01；r=0.445，P<0.01）；治疗后O/OCC与治疗后CAS有中度相关性（r=0.555，P<0.01），而治疗后N与治疗后CAS无相关性（r=0.235，P>0.01）。结论　99mTc-奥曲肽眼眶SPECT/CT显像在评价活动期TAO治疗效果上具有较好的应用价值。（眼科，2013, 22： 309-312）

关键词: 甲状腺相关性眼病, 锝, 放射性核素显像, 奥曲肽

Abstract: Objective To explore the application of orbital 99mTc labeled octreotide SPECT/CT on the treatment effect evaluation of active thyroid associated ophthalmopathy(TAO). Design Retrospetive case series. Participants Twenty-one patients with active TAO were observed, with 37 afflicted eyes and 5 normal eyes. Methods Orbital 99mTc labeled octreotide SPECT/ CT and the clinical activity score (CAS) were separately performed before and after treatments in the patients with TAO. Main Outcome Measures An uptake ratio between the orbits and the occipital skull（O/OCC）, the numbers of involved extraocular muscles（N） and CAS. Results Before treatment,the average of N was 2.70±1.00 and its CAS was (5.49±2.04). Before treatments, the O/OCC of afflicted eyes(2.00±0.35) were higher than that in normal eyes(1.14±0.10)(P=0.000). After treatments, the O/OCC, CAS and N were (1.38±0.30), (1.78±1.18), (1.16±0.93) on average, respectively and significantly reduced compared to those before treatment in afflicted eyes（all P=0.000）. There was no statistical differences in normal eyes before and after treatments in the O/OCC(1.03±0.07) (P=0.242). A statistically significant correlation was found in the O/OCC versus CAS before and after treatments (r=0.574，P<0.01; r=0.555，P<0.01). A statistically significant correlation was also found in N versus CAS before treatments (r=0.445，P<0.01), but not found after treatments (r=0.235，P>0.01). Conclusion Orbital ^99mTc labeled octreotide SPECT/ CT is with good prospect in evaluating treatment effect of active TAO. (Ophthalmol CHN, 2013, 22: 309-312)

Key words: thyroid associated ophthalmopathy, technetium, radionuclide imaging, octreotide

罗莎, 王雪, 刘黎洁, 李眉 . ^99mTc-奥曲肽SPECT/CT对活动期甲状腺相关性眼病治疗的效果评价[J]. 眼科, 2013, 22(5): 309-312.

LUO Sha, WANG Xue, LIU Li-Jie, LI Mei- . The evaluation of treatment effect of active thyroid associated ophthalmopathy with ^99mTc labeled octreotide SPECT/CT[J]. Ophthalmology in China, 2013, 22(5): 309-312.

参考文献

［1］ Smith TJ. Pathogenesis of Graves' orbitopathy：a 2010 update. J Endocrinol Invest, 2010, 33: 414-421.

［2］罗清礼. 甲状腺相关性眼病. 北京: 人民卫生出版社, 2005: 95-308.

［3］王颖, 王雪, 王峰, 等. 99mTc-奥曲肽眼眶显像在甲状腺相关性眼病中的应用. 北京医学, 2011, 33: 292-294.

［4］李眉, 戴皓洁, 王雪, 等. 99mTc-奥曲肽SPECT/CT评价甲状腺相关性眼病活动期. 中国医学影像技术, 2011, 27: 505-509.

［5］ Salvi M, Vannucchi G, Campi L, et al. Treatment of Graves' disease and associated ophthalmopathy with the anti-CD20 monoclonal antibody rituximab: an open study. Eur J Endocrinol, 2007, 156: 33-40.

［6］ Bartalena L, Baldeschi L, Dickinson A, et al. Consensus statement of the European Group on Graves’ orbitopathy (EUGOGO) on management of GO. Eur J Endocrinol, 2008, 158: 273-285.

［7］鲜军舫. 头颈部影像诊断必读. 北京: 人民军医出版社, 2007: 15.

［8］ Garrity JA, Bahn RS. Pathogenesis of Graves’ophthalmopathy: implications for prediction, prevention and treatment. Am J Ophthalmol, 2006, 142: 147-153.

［9］ Perros P, Krassas GE. Graves orbitopathy: A perspective. Nat Rev Endocrinol, 2009, 5: 312-318.

［10］ Pasquali D, Notaro A, Bonarolorta G, et al. Somatostatin receptor genes are expressed in lymphocytes from retro orbital tissues in Graves’ disease. J Clin Endocrinol Metab, 2002, 87: 5125-5129.

［11］ Khanna G, Bushnell D, O’Dorisio MS. Utility of radiolabeled somatostatin receptor analogues for staging/ restaging and treatment of somatostatin receptor positive pediatric tumors. Oncologist, 2008, 13: 382-389.

［12］ Postema PTE, Krenning EP, Wijingaarde R, et al. 111-In DTPA-D-Phe1 octreotide scintigraphy in thyroidal and orbital Graves’ disease: A parameter for disease activity?. J Clin Endocrinol Metab, 1994, 79: 1845-1851.

［13］ Laszlo G, Andras L, Zsolt SF, et al. Imaging of disease activity in Graves’orbitopathy with different methods: comparison of 99mTc-DTPA and 99mTc-depreotide single photon emission tomography, magnetic resonance imaging and clinical activity scores. Nucl Med Commun, 2005, 26: 407-414.

[1]	李眉燕飞. 医学影像学评估甲状腺相关性眼病活动度的价值[J]. 眼科, 2018, 27(5): 321-324.
[2]	拓秀信中闫钟钰刘云福. CT眼眶结构定量分析在甲状腺相关性眼病活动性评价中的作用[J]. 眼科, 2018, 27(5): 333-337.
[3]	姜虹燕飞鲜军舫艾立坤王雪. T2 mapping MRI评估甲状腺相关性眼病免疫抑制疗效的初步研究[J]. 眼科, 2018, 27(5): 339-343.
[4]	罗莎王爽李眉刘黎洁信中. ^99mTc-DTPA眼眶 SPECT/CT评价甲状腺相关性眼病活动性[J]. 眼科, 2018, 27(5): 344-348.
[5]	周立萍李佳刘明明袁洪峰. 糖皮质激素不同给药方式治疗中重度甲状腺相关性眼病的Meta分析[J]. 眼科, 2018, 27(4): 269-275.
[6]	孙斌. 生长抑素类似物眼眶显像在甲状腺相关性眼病诊疗中的应用[J]. 眼科, 2016, 25(6): 361-364.
[7]	鲍春丽李婷孙斌 . 儿童甲状腺相关性眼病的临床特点及眼眶显像在其诊断中的应用[J]. 眼科, 2016, 25(6): 366-370.
[8]	周晓晴顾燕华张韵马晓晔魏锐利. 免疫抑制剂冲击治疗对甲状腺相关性眼病患者眼表的影响[J]. 眼科, 2016, 25(1): 40-44.
[9]	艾立坤胡依博吴怡满凤媛王雪. 甲状腺相关性眼病提上睑肌的MRI表现[J]. 眼科, 2014, 23(5): 326-331.
[10]	胡依博, 艾立坤, 吴怡, 顼晓琳, 陈雪. 甲状腺相关性眼病眶内组织的病理改变[J]. 眼科, 2014, 23(2): 130-134.
[11]	燕飞, 李眉. 重视医学影像学在眼外肌麻痹病因诊断中的价值[J]. 眼科, 2013, 22(5): 289-291.