全身骨显像诊断肺癌骨转移临床价值［摘要］目的：探讨全身骨显像在诊断肺癌骨转移的临床价值，以便更好地指导肺癌患者的分期及治疗。方法：126例病理确诊为肺癌的患者均行全身骨显像、CT及碱性磷酸酶、血钙检查。统计肺癌患者不同病理类型、不同临床分期发生骨转移的几率，将全身骨显像与可疑骨转移临床因素(包括骨痛、碱性磷酸酶升高、高钙血症中任意一项或几项)诊断骨转移的准确性进行统计学比较。结果：肺癌骨转移的发生率为27.8%,周围型肺癌较中央型肺癌骨转移发生率高(P<0.01),肺腺癌较肺鳞癌骨转移发生率高(PV0.01),III、IV期患者骨转移发生率明显高于I、II期的患者(P<0.01)o全身骨显像诊断肺癌骨转移的灵敏度(94.3%)、特异性(84.6%)、准确性(87.3%)均高于可疑骨转移临床因素对骨转移的诊断。结论：肺癌患者应常规行全身骨显像，这对肺癌的分期、治疗有着重要的临床意义。［关键词］肺癌；全身骨显像；骨转移［中图分类号］R734.2［文献标识码］B［文章编号］1673-7210(2011)11(c)-103-03ClinicalvalueofthewholebodyboneimagingindiagnosingbonemetastasisfromlungcancerJIALil,XIAZhengwu2,MAShixingl1.DepartmentofNuclearMedicine,YunnanProvincalCancerHospital,YunnanProvince,Kunming650118,China；2.DepartmentofLaboratory,KunmingGeneralHospitalofPLA,YurinanProvince,Kunming650032,China[Abstract]Objective：Toexploreclinicalvalueofthewholebodyboneimagingindiagnosingbonemetastasisfromlungcancer,inordertoguidestagingandtreatmentofpatientswithlungcancer.Methods：126patientswithpathologicaldiagnosisoflungcancerwereperformedwholebodyboneimaging,CTandALP,bloodcalciuminspection.Probabilityofbonemetastasisfromlungcancerofthedifferentpathologicaltypeanddifferentclinicalstagewerecounted.Thewholebodyboneimagingandclinicalfactorsofsuspiciousbonemetastasis(includingbonepain,alkalinephosphatase,highcalciumlevels,arbitraryorafew)fordiagnosisaccuracyofbonemetastaseswerestatisticalcompared.Results：Theincidenceofbonemetastasisfromlungcancerwas27.8%,andthebonemetastasesoccurrenceprobabilityofperipherallungcancerwashigherthancentrallungcancer(P<0.01),bonemetastasesoccurrenceprobabilityoflungadenocarcinomawashigherthanlungsquamouscellcarcinoma(P<0.01),bonemetastasesoccurrenceprobabilityofperiodIII,IVpatientswasobviouslyhigherthanthatofperiodI,II(P<0.01).Thesensitivity(94.3%),specificdegrees(84.6%),accuracy(87・3%)ofthewholebodyboneimagingdiagnosisofbonemetastasesfromlungcancerwerehigherthantheclinicalfactorsofsuspiciousbonemetastasisdiagnosisofbonemetastases・Conclusion：Wholebodyboneimagingshouldbearoutineexaminationinpatientswithlungcancer.Theclinicalsignificaneeisimportanttodeterminestageandtreatmentoflun£cancer.[Keywords]Lungcancer；Wholebodyboneimaging；Bonemetastasis肺癌是临床上常见的恶性肿瘤，20%〜40%患者发生骨转移[1],将严重影响患者的生活质量及生存期。早期发现骨转移对指导肺癌的临床治疗非常重要。本研究回顾165例病理确诊为肺癌患者的临床资料，探讨全身骨显像及可能发生骨转移的临床因素在诊断肺癌骨转移中的临床价值。1资料与方法1.1一般资料2009年3〜9月在我院经支纤镜取材，病理证实为肺癌的患者126例，均行全身骨显像、CT（胸部、腹部及头颅）及碱性磷酸酶、血钙检查，并随访1年以上。其中，男96例，女30例；年龄28〜80岁，平均58.2岁。按照WHO肺癌组织的病理类型分为腺癌、鳞癌、未分化癌（包括大细胞未分化癌、小细胞癌）[2],其中，腺癌64例，鳞癌52例,未分化癌10例；周围性肺癌44例，中央性肺癌82例。按照肺癌TNM分期（UICC2009年版）法分为I〜IV期[2],其中I、II期36例，III、IV期90例；临床可疑骨转移因素（包括骨痛、碱性磷酸酶升高、高钙血症任一项）35例。1.2方法静脉注射99Tcm-MDP（标记率〉95%）740〜925MBq,注射后...