中华核医学与分子影像杂志
中華覈醫學與分子影像雜誌
중화핵의학여분자영상잡지
Chinese Journal of Nuclear Medicine and Molecular Imaging
2014年
5期
358-361
,共4页
张梅虹%赵瑞芳%陈瑞%王建设
張梅虹%趙瑞芳%陳瑞%王建設
장매홍%조서방%진서%왕건설
胆汁郁积,肝内%婴儿,新生%放射性核素显像%EHIDA
膽汁鬱積,肝內%嬰兒,新生%放射性覈素顯像%EHIDA
담즙욱적,간내%영인,신생%방사성핵소현상%EHIDA
Cholestasis,intraphepatic%Infant,newborn%Radionuclide imaging%EHIDA
目的 探讨citrin缺陷导致的婴儿肝内胆汁淤积症(NICCD)患儿99Tcm-二乙基乙酰苯胺亚氨二醋酸(EHIDA)肝胆显像的特征.方法 回顾性分析28例(男16例,女12例,1～8月龄)经基因确诊、同时行99Tcm-EHIDA肝胆动态显像检查的NICCD患儿资料.肝胆动态显像时心、肝、肾按正常时序和强度显影定义为摄取功能正常,肝影模糊和(或)心肾影持续时间延长者为摄取功能差;60 min内肠道显影为排泄通畅,60 min后为排泄延迟,24 h肠道仍不显影为排泄受阻.分析肝胆显像特征与血清总胆红素(TB)、直接胆红素(DB)、ALT、总胆汁酸(TBA)等指标间的关系.数据分析采用Kruskal-Wallis秩和检验.结果 28例中,20例表现为摄取功能正常,其中10例排泄通畅,10例排泄延迟;8例表现为摄取功能差,其中4例排泄延迟,4例排泄受阻.与摄取功能正常组相比,摄取功能差组TB和DB明显增高[183.6(128.7～ 280.9) mmol/L和105.5(80.0～ 141.7) mmol/L,135.6(95.7～212.6) mmol/L和73.1(53.9～ 97.9) mmol/L;Z=-2.25和-2.73,均P＜0.05].与排泄通畅者相比,排泄延迟者TB、DB和TBA明显升高[分别为137.5(122.0～170.9) mmol/L和81.7(65.7～93.5) mmol/L,96.5(81.1～ 108.0) mmol/L和54.1(45.3～72.6) mmol/L,245.6(183.9～299.2) mmol/L和136.0(73.5 ～163.2) mmol/L;Z=-3.92、-3.74和-2.57,均P＜0.05];排泄受阻者TB[262.0(152.1 ～ 542.8) mmol/L]和DB[192.7(118.1～407.2) mmol/L]更高(均Z=-2.82,均P＜0.05).与排泄延迟组相比,排泄受阻者ALT明显增高[71.5(48.5～144.8) U/L和20.0(16.5～27.7) U/L;Z=-2.66,P＜0.05).结论 99Tcm-EHIDA肝胆显像可反映NICCD患儿肝脏摄取和排泄功能受损的状况,摄取功能受损严重时,可出现排泄受阻的征象.
目的 探討citrin缺陷導緻的嬰兒肝內膽汁淤積癥(NICCD)患兒99Tcm-二乙基乙酰苯胺亞氨二醋痠(EHIDA)肝膽顯像的特徵.方法 迴顧性分析28例(男16例,女12例,1～8月齡)經基因確診、同時行99Tcm-EHIDA肝膽動態顯像檢查的NICCD患兒資料.肝膽動態顯像時心、肝、腎按正常時序和彊度顯影定義為攝取功能正常,肝影模糊和(或)心腎影持續時間延長者為攝取功能差;60 min內腸道顯影為排洩通暢,60 min後為排洩延遲,24 h腸道仍不顯影為排洩受阻.分析肝膽顯像特徵與血清總膽紅素(TB)、直接膽紅素(DB)、ALT、總膽汁痠(TBA)等指標間的關繫.數據分析採用Kruskal-Wallis秩和檢驗.結果 28例中,20例錶現為攝取功能正常,其中10例排洩通暢,10例排洩延遲;8例錶現為攝取功能差,其中4例排洩延遲,4例排洩受阻.與攝取功能正常組相比,攝取功能差組TB和DB明顯增高[183.6(128.7～ 280.9) mmol/L和105.5(80.0～ 141.7) mmol/L,135.6(95.7～212.6) mmol/L和73.1(53.9～ 97.9) mmol/L;Z=-2.25和-2.73,均P＜0.05].與排洩通暢者相比,排洩延遲者TB、DB和TBA明顯升高[分彆為137.5(122.0～170.9) mmol/L和81.7(65.7～93.5) mmol/L,96.5(81.1～ 108.0) mmol/L和54.1(45.3～72.6) mmol/L,245.6(183.9～299.2) mmol/L和136.0(73.5 ～163.2) mmol/L;Z=-3.92、-3.74和-2.57,均P＜0.05];排洩受阻者TB[262.0(152.1 ～ 542.8) mmol/L]和DB[192.7(118.1～407.2) mmol/L]更高(均Z=-2.82,均P＜0.05).與排洩延遲組相比,排洩受阻者ALT明顯增高[71.5(48.5～144.8) U/L和20.0(16.5～27.7) U/L;Z=-2.66,P＜0.05).結論 99Tcm-EHIDA肝膽顯像可反映NICCD患兒肝髒攝取和排洩功能受損的狀況,攝取功能受損嚴重時,可齣現排洩受阻的徵象.
목적 탐토citrin결함도치적영인간내담즙어적증(NICCD)환인99Tcm-이을기을선분알아안이작산(EHIDA)간담현상적특정.방법 회고성분석28례(남16례,녀12례,1～8월령)경기인학진、동시행99Tcm-EHIDA간담동태현상검사적NICCD환인자료.간담동태현상시심、간、신안정상시서화강도현영정의위섭취공능정상,간영모호화(혹)심신영지속시간연장자위섭취공능차;60 min내장도현영위배설통창,60 min후위배설연지,24 h장도잉불현영위배설수조.분석간담현상특정여혈청총담홍소(TB)、직접담홍소(DB)、ALT、총담즙산(TBA)등지표간적관계.수거분석채용Kruskal-Wallis질화검험.결과 28례중,20례표현위섭취공능정상,기중10례배설통창,10례배설연지;8례표현위섭취공능차,기중4례배설연지,4례배설수조.여섭취공능정상조상비,섭취공능차조TB화DB명현증고[183.6(128.7～ 280.9) mmol/L화105.5(80.0～ 141.7) mmol/L,135.6(95.7～212.6) mmol/L화73.1(53.9～ 97.9) mmol/L;Z=-2.25화-2.73,균P＜0.05].여배설통창자상비,배설연지자TB、DB화TBA명현승고[분별위137.5(122.0～170.9) mmol/L화81.7(65.7～93.5) mmol/L,96.5(81.1～ 108.0) mmol/L화54.1(45.3～72.6) mmol/L,245.6(183.9～299.2) mmol/L화136.0(73.5 ～163.2) mmol/L;Z=-3.92、-3.74화-2.57,균P＜0.05];배설수조자TB[262.0(152.1 ～ 542.8) mmol/L]화DB[192.7(118.1～407.2) mmol/L]경고(균Z=-2.82,균P＜0.05).여배설연지조상비,배설수조자ALT명현증고[71.5(48.5～144.8) U/L화20.0(16.5～27.7) U/L;Z=-2.66,P＜0.05).결론 99Tcm-EHIDA간담현상가반영NICCD환인간장섭취화배설공능수손적상황,섭취공능수손엄중시,가출현배설수조적정상.
Objective To investigate the scintigraphic features of neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) and to explore the clinical significance of 99Tcm-EHIDA hepatobiliary scintigraphy.Methods Hepatobiliary scintigraphy with 99Tcm-EHIDA was performed in 28 genetic confirmed NICCD cases (16 males,12 females,1-8 months).Normal dynamics (i.e.,time-activity curve) of the tracer in heart,liver and kidneys was defined as normal hepatic uptake function.Decreased liver uptake of the tracer and/or prolonged heart and kidneys radioactivity retention was defined as impaired hepatic uptake function.Normal or delayed biliary excretion was defined as radioactivity appearing in the bowel within 60 min or after 60 min.Occluded biliary excretion was defined as absent bowel radioactivity within 24 h.The characteristics of hepatobiliary scintigraphy and their relationship with levels of serum total bilirubin (TB),direct bilirubin(DB),ALT,total bile acid (TBA) were retrospectively analyzed.Statistical analysis was performed using Kruskal-Wallis rank sum test.Results Of 28 NICCD patients,20 showed normal uptake while 8 had impaired hepatic uptake.Ten of twenty patients with normal uptake function showed normal biliary excretion and the others showed delayed biliary excretion.Four of eight cases who presented impaired hepatic uptake function were with delayed biliary and the rest displayed biliary excretion occlusion.Compared with the patients with normal hepatic uptake function,patients with impaired hepatic uptake had significantly higher levels of TB and DB (TB:183.6(128.7-280.9) mmol/L vs 105.5(80.0-141.7) mmol/L,Z=-2.25;DB:135.6 (95.7-212.6) mmol/L vs 73.1(53.9-97.9) mmol/L,Z=-2.73; both P＜0.05).Compared with the cases with normal biliary excretion function,patients with delayed biliary excretion had significantly higher levels of TB,DB and TBA (TB:137.5 (122.0-170.9) mmol/L vs 81.7(65.7-93.5) mmol/L,Z=-3.92;DB:96.5 (81.1-108.0) mrrol/L vs 54.1(45.3-72.6) mmol/L,Z=-3.74; TBA:245.6(183.9-299.2) mmol/L vs 136.0(73.5-163.2) mmol/L,Z=-2.57; all P＜0.05).The levels of TB (262.0(152.1-542.8) mmol/L) and DB (192.7(118.1-407.2) mmol/L; both Z=-2.82; both P＜0.05) were the highest in patients with occluded biliary excretion.Compared with the patients with delayed excretion,the occluded excretion subgroup had significantly higher levels of ALT (71.5 (48.5-144.8) U/L vs 20.0(16.5-27.7) U/L,Z=-2.66,P＜0.05).Conclusion 99Tcm-EHIDA hepatobiliary scintigraphy may evaluate hepatic uptake and excretion function of the NICCD infants.When the hepatic uptake is remarkably decreased,the occluded biliary excretion can be shown.
