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PET/CT融合了结构和功能显像,在肿瘤患者的诊断、分期及预后评估中的应用越来越广泛[1]。18F-FDG的分子结构与葡萄糖类似,可被代谢旺盛的肿瘤组织摄取并显像,但患者血糖水平升高时,肿瘤摄取18F-FDG减少[2],病灶与本底的对比度降低,影响肿瘤病灶的检出率。目前,糖尿病患者在行PET/CT检查前,需使用降糖药物将空腹血糖水平控制在11.1 mmol/L以下。
二甲双胍是临床指南推荐的Ⅱ型糖尿病一线治疗药物,近年来还作为辅助化疗药物应用于肿瘤患者[3]。既往研究结果表明,使用二甲双胍的糖尿病患者肠道18F-FDG摄取呈弥漫性、连续性增高[4],影响肠道肿瘤病灶的诊断。有指南建议糖尿病患者18F-FDG检查前48 h停用二甲双胍[4],但停药导致的血糖水平升高也会降低病灶的检出率。胰岛素是糖尿病患者常用的另一种降血糖药物[5],胰岛素的使用会导致肌肉组织对18F-FDG的高摄取。目前,有关胰岛素对肠道18F-FDG摄取的影响的临床研究较少。我们回顾性分析服用二甲双胍和胰岛素治疗的糖尿病患者的18F-FDG PET/CT影像学资料,对比分析2种降血糖药物在糖尿病患者行18F-FDG PET/CT检查时肠道摄取18F-FDG的差异。
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共纳入受检者108名,其中二甲双胍治疗组38例(男性22例、女性16例)、胰岛素治疗组32例(男性19例、女性13例)、对照组38名(男性22名,女性16名)。3组受检者在性别间的差异无统计学意义(χ2=0.020,P=0.990)。由表1可知,3组受检者的身高、体重、体重指数、显像剂注射剂量、主动脉SUVmax和肝脏SUVmax间的差异均无统计学意义(均P>0.05)。二甲双胍治疗组和胰岛素治疗组患者的空腹血糖高于对照组(均P<0.05),其中胰岛素治疗组患者的空腹血糖水平略高于二甲双胍治疗组,且差异有统计学意义(P<0.05);与对照组比较,二甲双胍治疗组和胰岛素治疗组的患者年龄更大,且差异均有统计学意义(均P<0.01)。
组别 年龄
(岁)身高
(m)体重
(kg)体重指数
(kg/m2)空腹血糖
(mmol/L)显像剂注射剂量
(MBq)主动脉
SUVmax肝脏
SUVmax二甲双胍治疗组
(n=38)62.82±10.46a 1.67±0.08 68.67±12.69 24.43±3.41 7.09±1.35a 221.82±47.10 2.62±0.42a 3.62±0.51 胰岛素治疗组
(n=32)63.13±9.99a 1.69±0.08 64.11±11.82 22.43±2.99b 7.86±1.88a,b 206.81±41.97 2.62±0.33a 3.55±0.42 对照组(n=38) 55.00±12.98 1.67±0.07 66.15±12.92 23.51±3.71 5.17±0.50 221.25±45.58 2.43±0.44 3.42±0.63 F值 6.885 0.354 1.178 3.306 44.608 1.227 3.063 1.526 P值 0.002 0.702 0.312 0.052 <0.001 0.297 0.051 0.222 注:a表示与对照组比较,差异均有统计学意义(F=3.083、2.978、8.796、9.119、1.995、2.133,P=0.003、0.004、0.001、0.001、0.049、0.036);b表示与二甲双胍治疗组比较,差异均有统计学意义(F=2.612、2.015, P=0.011、0.048)。SUVmax为最大标准化摄取值 表 1 二甲双胍治疗组、胰岛素治疗组糖尿病患者和对照组受检者临床资料和SUVmax的比较(
±s)$\bar x $ Table 1. Comparison of clinical data and maximum standardized uptake value of patients with diabetes mellitus in metformin treatment group, insulin treatment group and the subjects in control group (
±s)$\bar x $ -
二甲双胍治疗组、胰岛素治疗组和对照组受检者肠道的18F-FDG摄取程度视觉评级结果显示,3组间的差异有统计学意义(H=17.412,P=0.001)。两两分析结果显示,二甲双胍治疗组18F-FDG PET/CT肠道图像的视觉评级与对照组和胰岛素治疗组间的差异均有统计学意义(H=25.988、21.548,P=0.001、P=0.015),而对照组与胰岛素治疗组间视觉评级的差异无统计学意义(H=4.440,P=1.000)。典型病例的18F-FDG PET/CT显像图见图1。
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由图2可见,肠道的SUVmax分段测量结果显示,与对照组比较,二甲双胍治疗组除十二指肠外,空肠(2.23±0.51对2.60±0.57)、回肠(2.19±0.66对2.95±1.66)、升结肠(2.65±1.03对4.56±3.09)、横结肠(2.09±0.83对3.37±2.15) 、降结肠(2.37±1.06对4.72±3.51)、乙状结肠(2.74±1.12对5.26±3.34)、直肠(3.40±1.06对5.74±3.27)的SUVmax均明显增高,且差异均有统计学意义(均 P<0.01);胰岛素治疗组的横结肠(2.09±0.83对2.71±1.65)、降结肠(2.37±1.06对3.35±2.72)、乙状结肠(2.74±1.12对3.79±2.68)的SUVmax均明显增高,且差异均有统计学意义(均P<0.05)。与胰岛素治疗组比较,二甲双胍治疗组的空肠(2.26±0.41对2.60±0.57)、回肠(2.13±0.58对2.95±1.66)、升结肠(2.84±1.15对4.56±3.09)、乙状结肠(3.79±2.68对5.26±3.34)、直肠(3.89±2.34对5.74±3.27)的SUVmax均明显增高,且差异均有统计学意义(均 P<0.05)。二甲双胍治疗组、胰岛素治疗组、对照组的右侧股直肌SUVmax的差异无统计学意义(F=0.240,P=0.787)。
图 2 二甲双胍治疗组、胰岛素治疗组糖尿病患者和对照组受检者各段肠道及右侧股直肌18F-FDG摄取值SUVmax的比较
Figure 2. Comparison of maximum standardized uptake value of 18F-FDG uptake value of each segment of bowel and right rectus femoris muscle of diabetes patients in metformin treatment group, insulin treatment group and the subjects in control group
服用二甲双胍与胰岛素的糖尿病患者肠道摄取18F-FDG的比较
Comparison of the effects of metformin and insulin on intestinal 18F-FDG uptake in diabetic patients
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摘要:
目的 对比分析二甲双胍与胰岛素的使用对糖尿病患者行PET/CT检查时肠道摄取18F-氟脱氧葡萄糖(FDG)的影响。 方法 回顾性分析2017年1月至2019年1月于西安交通大学第一附属医院行18F-FDG PET/CT检查的70例Ⅱ型糖尿病患者的临床资料和影像学资料,其中男性41例、女性29例,年龄38~86(62.9±12.4)岁。根据使用的降血糖药物将患者分为二甲双胍治疗组和胰岛素治疗组。收集同期以健康体检或肿瘤筛查为检查目的的非糖尿病患者作为对照组(38名),其中男性22名、女性16名,年龄16~82(55.0±13.0)岁。对肠道 PET/CT图像的 18F-FDG摄取程度进行视觉评级,并测量各段肠道的最大标准化摄取值(SUVmax)。采用卡方检验比较3组受检者性别的差异;采用非参数Kruskal-Wallis秩和检验比较3组间肠道摄取程度的视觉评级并进行成对分析。采用单因素方差分析比较3组间一般临床资料及肠道各段和右侧股直肌SUVmax的差异,并采用LSD-t检验进一步行组间比较。 结果 二甲双胍治疗组患者肠道的18F-FDG摄取程度视觉评级与对照组和胰岛素治疗组之间的差异均有统计学意义(H=25.988、21.548,均P<0.05)。与对照组比较,二甲双胍治疗组除十二指肠外,空肠(2.23±0.51对2.60±0.57)、回肠(2.19±0.66对2.95±1.66)、升结肠(2.65±1.03对4.56±3.09)、横结肠(2.09±0.83对3.37±2.15) 、降结肠(2.37±1.06对4.72±3.51)、乙状结肠(2.74±1.12对5.26±3.34)、直肠(3.40±1.06对5.74±3.27)的SUVmax均明显增高,且差异均有统计学意义(t=2.133~4.699,均 P<0.01)。与胰岛素治疗组比较,二甲双胍治疗组的空肠(2.26±0.41对2.60±0.57)、回肠(2.13±0.58对2.95±1.66)、升结肠(2.84±1.15对4.56±3.09)、乙状结肠(3.79±2.68对5.26±3.34)、直肠(3.89±2.34对5.74±3.27)的SUVmax均明显增高,且差异均有统计学意义(t=2.002~2.977,均 P<0.05)。 结论 二甲双胍可导致糖尿病患者肠道摄取18F-FDG增加,而胰岛素对肠道摄取18F-FDG的影响较小。 -
关键词:
- 正电子发射断层显像术 /
- 体层摄影术,X线计算机 /
- 氟脱氧葡萄糖 /
- 糖尿病 /
- 二甲双胍 /
- 胰岛素
Abstract:Objective To compare the effects of metformin and insulin on the intestinal uptake of 18F-fluorodeoxyglucose (18F-FDG) in patients with diabetes mellitus undergoing PET/CT. Methods The clinical and imaging data of 70 diabetic patients (41 males and 29 females, aged between 38 and 86 (62.9±12.4) years old) who underwent 18F-FDG PET/CT examination in the First Affiliated Hospital of Xi'an Jiaotong University from January 2017 to January 2019 were retrospectively analyzed. The patients were divided into the metformin treatment group and insulin treatment group according to the hypoglycemic drugs used. Non-diabetic patients undergoing physical examination or tumor screening (38 cases, including 22 males and 16 females, aged between 16 and 82 (55.0±13.0) years old) were collected as the control group. The PET/CT images of the intestine were visually rated, and the 18F-FDG maximum standardized uptake value (SUVmax) of each segment of the intestine was measured. The Chi-square test was used to compare the gender differences of the subjects in the three groups. The nonparametric Kruskal–Wallis rank sum test was used to compare the visual rating of the extent of intestinal uptake in the three groups, and paired analysis was conducted. One-way analysis of variance was used to compare the general data and the differences in the SUVmax of each segment of the intestine and the right rectus femoris muscle among the three groups. Further comparisons were made between the groups by LSD-t test. Results Statistically significant differences were observed in the image visual score of the intestinal tract in the metformin treatment group and between the insulin treatment group and the control group (H=25.988, 21.548; both P<0.05). Compared with the control group, except for the duodenum, SUVmax of jejunum (2.23±0.51 vs. 2.60±0.57), ileum (2.19±0.66 vs. 2.95±1.66), ascending colon (2.65±1.03 vs. 4.56±3.09 ), transverse colon (2.09±0.83 vs. 3.37±2.15 ), descending colon (2.37±1.06 vs. 4.72±3.51), sigmoid colon (2.74±1.12 vs. 5.26±3.34), rectum (3.40±1.06 vs. 5.74±3.27) in metformin treatment group were significantly higher, and all differences were statistically significant (t=2.133–4.699, all P<0.05). Compared with the insulin treatment group, the SUVmax values of the jejunum (2.26±0.41 vs. 2.60±0.57), ileum (2.13±0.58 vs. 2.95±1.66), ascending colon (2.84±1.15 vs. 4.56±3.09), sigmoid colon (3.79±2.68 vs. 5.26±3.34), and rectum (3.89±2.34 vs. 5.74±3.27) in the metformin treatment group were significantly higher than those in the insulin treatment group, and all differences were statistically significant (t=2.002–2.977, all P<0.05). Conclusion Metformin can increase the intestinal uptake of 18F-FDG in diabetic patients, whereas insulin has less effect on the intestinal uptake of 18F-FDG. -
图 2 二甲双胍治疗组、胰岛素治疗组糖尿病患者和对照组受检者各段肠道及右侧股直肌18F-FDG摄取值SUVmax的比较
Figure 2. Comparison of maximum standardized uptake value of 18F-FDG uptake value of each segment of bowel and right rectus femoris muscle of diabetes patients in metformin treatment group, insulin treatment group and the subjects in control group
表 1 二甲双胍治疗组、胰岛素治疗组糖尿病患者和对照组受检者临床资料和SUVmax的比较(
±s)$\bar x $ Table 1. Comparison of clinical data and maximum standardized uptake value of patients with diabetes mellitus in metformin treatment group, insulin treatment group and the subjects in control group (
±s)$\bar x $ 组别 年龄
(岁)身高
(m)体重
(kg)体重指数
(kg/m2)空腹血糖
(mmol/L)显像剂注射剂量
(MBq)主动脉
SUVmax肝脏
SUVmax二甲双胍治疗组
(n=38)62.82±10.46a 1.67±0.08 68.67±12.69 24.43±3.41 7.09±1.35a 221.82±47.10 2.62±0.42a 3.62±0.51 胰岛素治疗组
(n=32)63.13±9.99a 1.69±0.08 64.11±11.82 22.43±2.99b 7.86±1.88a,b 206.81±41.97 2.62±0.33a 3.55±0.42 对照组(n=38) 55.00±12.98 1.67±0.07 66.15±12.92 23.51±3.71 5.17±0.50 221.25±45.58 2.43±0.44 3.42±0.63 F值 6.885 0.354 1.178 3.306 44.608 1.227 3.063 1.526 P值 0.002 0.702 0.312 0.052 <0.001 0.297 0.051 0.222 注:a表示与对照组比较,差异均有统计学意义(F=3.083、2.978、8.796、9.119、1.995、2.133,P=0.003、0.004、0.001、0.001、0.049、0.036);b表示与二甲双胍治疗组比较,差异均有统计学意义(F=2.612、2.015, P=0.011、0.048)。SUVmax为最大标准化摄取值 -
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