摘要
目的探讨氟代脱氧葡萄糖(18F-FDG)PET-CT代谢参数对1型自身免疫性胰腺炎(AIP)复发的预测价值。方法纳入2009年5月至2021年6月间解放军总医院86例符合国际共识诊断标准(ICDC)并在干预性治疗前行18F-FDG PET-CT检查的1型AIP患者,按治疗后是否AIP复发分为复发组(43例)和无复发组(43例)。采用标准摄取值(SUV)≥2.5固定阈值对胰腺病灶感兴趣容积(VOI)进行三维勾画,测量病灶三维直径、最大标准摄取值(SUV_(max))、平均标准化摄取值(SUVmean)、标准化摄取值峰值(SUV_(peak))、代谢肿瘤体积(MTV),计算病灶糖酵解总量(TLG)、靶本比(TBR)、标准摄取值比值(SUVR),比较两组患者的临床特征、生物化学指标及治疗情况,对两组胰腺病灶、胰腺外受累器官等18F-FDG PET-CT视觉指标及代谢参数进行单因素和多因素回归分析,构建复发预测模型并评估预测效能。结果无复发组中激素维持治疗患者比例明显高于复发组(58.1%比23.3%),复发组治疗前血清IgG4水平显著高于无复发组[(15309±11724)mg/L比(8816±7169)mg/L]。单因素分析结果显示,复发组胰腺外器官涎腺受累比例及VOI、SUV_(max)、SUV_(peak)、SUVR、TBR、MTV、TLG显著高于无复发组,差异均有统计学意义(P值均<0.05);多因素分析结果显示,复发组的VOI(OR=1.012,95%CI1.001~1.023)、SUV_(max)(OR=1.398,95%CI1.029~1.899),SUV_(peak)(OR=1.408,95%CI1.002~1.978)、SUVR(OR=1.977,95%CI1.036~3.771)、MTV(OR=1.012,95%CI1.000~1.022)显著高于无复发组,差异均有统计学意义(P值均<0.05)。将SUVR>2、MTV>36 cm3、IgG4>11400 mg/L进行多因素二元logistic回归分析构建预测模型,其AUC值为0.800(95%CI0.704~0.897),灵敏度为81.4%(95%CI0.661~0.911),特异度为74.4%(95%CI0.585~0.860),准确性为77.9%。结论18F-FDG PET-CT代谢参数可以作为1型AIP复发的预测因子;基于代谢参数SUVR、MTV及IgG4构建的多参数模型对1型AIP的复发有良好的预测效能。
Objective To investigate the predictive value of F-2-fluoro-2-deoxy-D-glucose(18F-FDG)PET-CT metabolic parameters for the recurrence of type 1 autoimmune pancreatitis(AIP).Methods Eighty-six patients with type 1 AIP who met the International Consensus Diagnostic Criteria(ICDC)and underwent 18F-FDG PET-CT before interventional treatment at the PLA General Hospital between May 2009 and June 2021 were included and divided into recurrence group(n=43)and no-recurrence group(n=43)according to whether they recurred after treatment.The standard uptake value(SUV)≥2.5 fixed threshold was used to outline the pancreatic lesion volume of interest(VOI)in three dimensions,and the three-dimensional diameter of the lesion,maximum standardized uptake value(SUV_(max)),mean standardized uptake value(SUV_(mean)),peak standardized uptake value(SUV_(peak)),metabolic tumor volume(MTV),total lesion glycolysis(TLG),target-to-bench ratio(TBR)and standardized uptake value ratio(SUVR)were measured to compare the clinical characteristics,biochemical indices and treatment of the two groups;univariate and multifactorial regression analysis were used to examine 18F-FDG PET/CT visual indices of pancreatic lesions and extra-pancreatic involved organs as well as metabolic parameters in the two groups.A recurrence prediction model was constructed and its predictive efficacy was assessed.Results The proportion of patients receiving glucocorticoid maintenance therapy was significantly higher in the no-recurrence group than in the recurrence group(58%vs 23.3%),and the serum IgG4 levels before treatment were significantly higher in the recurrence group[(15309±11724)mg/L vs(8816±7169)mg/L].The results of univariate analysis showed that the proportion of extra-pancreatic salivary gland involvement and VOI,SUV_(max),SUV_(peak),SUVR,TBR,MTV,and TLG were significantly higher in the recurrence group than in the no-recurrence group,and the differences were statistically significant(all P values<0.05);the results of multivariate analysis showed that VOI(OR=
作者
陈升鑫
翟亚奇
吴浪
陈德鑫
李明阳
Chen Shengxin;Zhai Yaqi;Wu Lang;Chen Dexin;Li Mingyang(Graduate School,Chinese PLA General Hospital,Beijing 100853,China;Department of Gastroenterology,First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)
出处
《中华胰腺病杂志》
CAS
2023年第2期92-98,共7页
Chinese Journal of Pancreatology
