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1、放射受体显像在甲状腺相关性眼病诊断中的临床应用硏究华中科技大学同济医学院附属同济医院核医学科硕士学位申请者:田金玲扌旨导教师:赵明副教授中文摘要目的:探讨得■奥曲肽(99mTC-OCT)显像在甲状腺相关性眼病诊断中的临床应用价值,以期寻找更为客观的定量评价方法,完善诊断评价的内容。方法:选择核医学科门诊因甲状腺疾病就诊以眼部不适为主诉(流泪、畏光、眼痛、视力改变、眼睑挛缩、突眼等)的患者19例共38只眼睛z以EUGOGO推荐的临床诊断评价标准将就诊患者共38只眼睛分为TAO组(30只)和非TAO组(8只);其中T
2、AO组按活动度分为活动组(24只)和非活动组(6只),按严重度分为轻度组(11只)和中■重度组(19只)。另招募健康志愿者5例,作为健康对照组(10只)。所有患者及健康对照者均行"mTc-OCTSPECT显像,对结果进行半走量分析”计算受检者眼部最高放射性计数与枕部头皮最低放射性计数比值(T/B)作为每只眼睛的站Tc・OCT摄取值,并行ROC曲线法分析。结果:非TAO组与健康对照组T/B有显著性差异(t二2.76zP=0.014);TAO组与健康对照组T/B有极显著性差异(t=5.86,P<0.001)eTAO组
3、和非TAO组T/B亦有极显著性差异(t二2.78,P二0.009),且TAO活动组和非活动组T/B有显著性差异(t二2.59,P二0.015)。ROC法曲线下面积TAO组和非TAO组为0.821、活动组和非活动组为0.854,获得最适界点的T/B比值分别为1.637及1.674;以此为界值,确诊TAO的灵敏度为83.3%、特异度87.5%、准确率84.2%;鉴别TAO活动期的灵敏度为87.5%、特异性83.3%.准确率86.7%。结论:99mTc-OCTSPECT显像结合半定量分析能较准确地确诊TAO及鉴别TAO
4、活动期,有益于指导TAO个体化治疗方案的制定。关键词:甲状腺相关性眼病;放射受体显像;奥曲肽;受试者工作曲线英文摘要(ABSTRACT)TheclinicalapplicationofTheradioreceptorimaginginthediagnosisofthyroidassociatedophthalmopathy(TAO)Mastercandidate:TianJinlingSupervisor:ProfessorZhaoMingDepartmentofNuclearMedicine,TongjiHos
5、pital,TongjiMedicalCollege,HuazhongUniversityofScienceandTechnologyABSTRACTObjective:Toevaluatethe99mTc-OCTSPECTimaginginthediagnosisofthyroidassociatedophthalmopathy(TAO).Methods:19outpatients(38eyes)inNuclearMedicinedepartmentwhosemaincomplaintisdiscomforta
6、roundeyearea(tearing,photophobiafeyepainfchangesinvisionzeyelidcontractureandexophthalmos)wereunderwentorbital99mTc-OCTSPECT.5healthyvolunteers(10eyes)recruited(healthycontrolgroup)wereunderwentthesameexamination.TakingtheEUGOGOclinicaldiagnosticcriteria,allo
7、utpatients*eyesweredividedintoTAOgroup(30)andnon-TAOgroup(8).Accordingtoitsclinicalactivityscore(CAS),theTAOgroupwasdividedintoactivegroup(24)andinactivegroup(6);andatthesametime,theTAOgroupwasdividedintomildgroup(11)andmoderate・severegroup(19)bythediseasesev
8、erity.Thentheratiosofthehighesteyeradioactivecount(T)tothelowestoccipitalscalpradioactivecount(B)inalleyeswerecalculated,astheeye99mTc-OCTintake・Receiveroperatingcharacteristic(ROC)analys