摘要
目的探讨分化型甲状腺癌（DTC）手术及^131Ⅰ清除剩余甲状腺组织（清甲）后复发时^99Tc^m-甲氧基异丁基异腈（MIBI）显像的特点及耐药蛋白（P-糖蛋白，P—gp）的表达。方法经手术病理检查确诊为DTC、清甲治疗后患者173例，术前均行^99Tc^m-MIBI双时相甲状腺局部静态显像，图像由3位有经验的核医学科医师集体阅片，计算^99Tc^m-MIBI显像早期（10min）、延迟（120min）肿瘤／正常组织放射性（T／NT）比值及洗脱率，术后4～6周行清甲。3年内复发9例为复发组，单纯随机抽样法选择未复发病例9例为无复发组。选取术后癌组织保存标本，采用免疫组织化学法及反转录-聚合酶链反应（RT-PCR）技术检测P—gp的表达。统计学处理采用SPSS10．0软件，行t检验及Spearman秩相关分析。结果DTC复发组早期、延迟相T／NT比值及洗脱率分别为1．18±0．28，1．16±0．24和（17．00±2．91）％，无复发组分别为1．54±0．26，1．65±0．26和（7．00±3．21）％，差异均有统计学意义（t=2．835，4．152，6．924，P均〈0．01）；DTC组织中P—gp的阳性细胞数比率复发组为（43．00±8．21）％，明显高于无复发组的（26．00±6．91）％（t=4．753，P〈0．01），不同病理类型间阳性细胞数比率差异无统计学意义（t=0．176，P〉0．05）；DTC组织中P—gp的基因表达量复发组为0．60±0．12，明显高于无复发组的0．31±0．19（t=3．871，P〈0．01），不同病理类型DTC的P—gp基因表达量差异无统计学意义（t=0．337，P〉0．05）。免疫组织化学及RT—PCR结果均提示：DTC患者癌组织中的P—gp表达与^99Tc^m-MIBI显像洗脱率之间均存在直线正相关（r=0．84和0．79，P均〈0．05）。结论^99Tc^m-MIBI显像早期、延迟T／NT比值及洗脱率与DTC清甲后复发关系密切，DTC原发灶清除^99Tc^m-MIBI的能力可在体反映P—gp的活性，原发灶^99Tc^m-MIBI的洗脱率可以预测其术后复发。
Objective The aim of this study was to evaluate the relationship between ^99Tc^m-methoxyisobutylisonitrile （MIBI） imaging and P-glycoprotein （P-gp） expression in patient with recurrent differentiated thyroid carcinoma （DTC） after primary definitive thyroidectomy and adjuvant ^131 Ⅰ ablation after operation. Methods A total of 173 pathologically confirmed DTC patients were included. All had twophase ^99Tc^m-MIBI static imaging preoperatively. Both early （ 10 min after intravenous injection） and delayed （120 min after intravenous injection） ^99Tc^m-MIBI tumor/non-tumor （T/NT） ratios and wash-out rates were calculated. Imaging results were analyzed by three experienced nuclear medicine physicians. At the time of follow-up （three years after diagnosis）, nine （5.20%） had local tumor recurrence. Nine non-recurrent disease patients were randomized selected as controls. The postoperative carcinoma tissue specimens were obtained to detect P-gp expression through immunohistochemical staining and RT-PCR technique. T test and Spearman correlation were done with SPSS 10.0. Results In recurrent group, the early and late T/NT ra- tios and wash-out rates were 1.18 ±0.28, 1.16 ± 0.24, and （ 17.00 ± 2.91 ） %. In non-recurrent group, the early and late T/NT ratios and wash-out rates were 1.54 ±0.26, 1.65 ±0.26, and （7.00 ±3.21） %. Statistically higher P-gp positive cell number and P-gp gene expression were noted in recurrent than in nonrecurrent groups [ （43.00 ± 8.21）% vs （26. 00 ±6.91）%, t =4. 753, P 〈0.01 and 0.60 ± 0.12 vs 0. 31 ±0.19, t = 3. 871, P 〈 0.01 ）. Moreover, positive correlation was noted between P-gp expression and 99Tcm-MIBI wash-out rate among DTC patients （ r = 0.84, P 〈 0.05 and r = 0.79, P 〈 0.05）. Conclusions P-gp expression was positively correlated with ^99Tc^m-MIBI wash-out rate among DTC patients and was significantly higher in recurrent than in non-recurrent groups, which might be due to higher P-gp positive cell number in recurrent than in non-recurrent groups.
出处
《中华核医学杂志》
CAS
CSCD
北大核心
2008年第6期393-396,共4页
Chinese Journal of Nuclear Medicine
