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SPECT/CT放射性核素骨显像是目前最能体现核医学影像技术优势且临床使用频率最高的核医学检查项目之一,约占单光子显像的63.1%[1]。超级骨显像是一种放射性核素骨显像的特殊影像学表现,其最初于1975年由Osmond等[2]提出,指全身骨骼显像中显像剂呈均匀、对称性异常放射性浓聚,骨骼显像异常清晰,而软组织内分布极低,双肾和膀胱不显影或仅隐约显影。超级骨显像见于多种良、恶性疾病,其中最常见于恶性肿瘤广泛性骨转移和代谢性骨病[3-5]。随着影像学技术的发展和仪器设备的革新,SPECT/CT实现了SPECT与CT的同机融合,既能反映病灶的骨盐代谢程度,又能清晰显示局部病灶的解剖结构、形态及骨质密度的改变,实现了“1+1>2”的优势。目前关于超级骨显像的研究多数仅为SPECT全身骨显像,而对SPECT/CT(即SPECT功能显像与CT解剖显像同机融合)的研究尚不成熟,也缺乏SPECT/CT显像结合患者的临床表现、实验室检查指标、病灶的解剖及密度等研究,不能完全体现不同病因导致的超级骨显像的特点。我们回顾性分析97例骨转移瘤和代谢性骨病患者的99Tcm-MDP SPECT/CT超级骨显像影像学特征、临床表现、年龄及实验室检查结果的差异,旨在提高临床医师对超级骨显像的认知。
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超级骨显像的阳性率为0.2%(97/47 671),其中骨转移瘤占73.2%(71/97)、代谢性骨病占26.8%(26/97)。所有患者均以骨痛为初发症状,局部骨痛占56.7%(55/97)、无骨痛占30.9%(30/97)、全身骨痛占12.4%(12/97),局部骨痛患者中,腰痛较为常见,占49.1%(27/55)。所有患者均无外伤史。
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由表1可知,骨转移瘤组以灶性散在分布型(Ⅱ型)为主(85.9%),代谢性骨病组主要呈均匀对称型( Ⅰ型,61.5%),99Tcm-MDP SPECT显像模式组间差异有统计学意义(χ2=21.84,P<0.001); 在SPECT/CT融合显像上,骨转移瘤组病灶多为成骨型或混合型骨质破坏(74.6%、19.7%),而代谢性骨病组病灶多为溶骨型骨质破坏(73.1%)。另外,所有代谢性骨病患者肾脏显影均不清,其中14例颅骨99Tcm-MDP摄取增加,形成“头盔征”;5例表现为肋骨“串珠征”;2例中轴骨99Tcm-MDP摄取增加;6例长骨99Tcm-MDP摄取增加;2例表现为胸骨“领带征”;4例关节周围区域99Tcm-MDP摄取增加。骨转移瘤(前列腺癌患者)及代谢性骨病(甲状旁腺瘤患者)的典型病例图像见图1、2。
组别 99Tcm-MDP SPECT 99Tcm-MDP SPECT/CT Ⅰ型 Ⅱ型 成骨型 溶骨型 混合型 骨转移瘤组(n=71) 10(14.1%) 61(85.9%) 53(74.6%) 4(5.7%) 14(19.7%) 代谢性骨病组(n=26) 16(61.5%) 10(38.5%) 5(19.2%) 19(73.1%) 2(7.7%) χ2值 21.84 43.74 P值 <0.001 <0.001 注:骨转移瘤组以成骨型和混合型骨质破坏为主,而代谢性骨病组以溶骨型骨质破坏为主,差异均有统计学意义(χ2=39.76、15.95,均 P<0.001)。MDP为亚甲基二膦酸盐;SPECT为单光子发射计算机体层摄影术;CT为计算机体层摄影术 表 1 骨转移瘤组与代谢性骨病组患者的影像学特征比较[例(%)]
Table 1. Comparison of imaging features between patients with bone metastases and metabolic bone disease (case(%))
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由表2可知,因病变部位不同,骨转移瘤组和代谢性骨病组患者临床表现的差异无统计学意义(P=0.356),局部骨痛的差异有统计学意义(P=0.008)。骨转移瘤组患者的局部骨痛主要为腰痛(60.0%),而代谢性骨病组患者以肋骨痛(40.0%)为主,差异有统计学意义(P=0.003)。由表3可知,骨转移瘤组患者年龄和ALP、LDH水平均高于代谢性骨病组,而血钙水平则低于代谢性骨病组,差异均有统计学意义(均P<0.05);而2组患者在血磷水平上的差异无统计学意义(P>0.05)。
组别 临床表现 局部骨痛 全身骨痛 局部骨痛 无骨痛 腰痛 肋骨痛 四肢痛 其他 骨转移瘤组(n=71) 7(9.9%) 40(56.3%) 24(33.8%) 24(60.0%) 3(7.5%) 6(15.0%) 7(17.5%) 代谢性骨病组(n=26) 5(19.2%) 15(57.7%) 6(23.1%) 3(20.0%) 6(40.0%) 4(26.7%) 2(13.3%) χ2值 2.09 10.88 P值 0.356 0.008 注:骨转移瘤组患者的局部骨痛主要为腰痛,而代谢性骨病组患者的局部骨痛主要为肋骨痛,差异有统计学意义(χ2=11.11,P=0.003) 表 2 骨转移瘤组与代谢性骨病组患者的临床表现和局部骨痛的比较[例(%)]
Table 2. Comparison of clinical manifestations and regional bone pain between patients with bone metastases and metabolic bone diseases (case(%))
组别 年龄( , 岁)$\bar x \pm s $ 血钙( , mmol/L)$\bar x \pm s $ 血磷( , mmol/L)$\bar x \pm s $ ALP[M(Q1, Q3),U/L] LDH[M( Q1, Q3),U/L] 骨转移瘤组(n=71) 65.25±12.32 2.16±0.19 1.04±0.27 520.50(242.25, 1024.50) 338.00(193.50, 677.50) 代谢性骨病组(n=26) 50.85±14.26 2.59±0.35 1.04±0.67 284.35(138.65, 559.00) 172.00(111.25, 249.25) 检验值 t=4.89 t=−5.96 t=0.01 Z=−2.28 Z=−3.65 P值 <0.001 <0.001 0.990 0.023 <0.0001 注:由于14例患者实验室检查指标的水平与显像时间相差较大,且2组患者中有3例无ALP、LDH,故均未进行统计学分析,行统计学分析的患者例数:血钙和血磷各83例、ALP和LDH各80例。实验室检查指标的正常参考值:血钙2.25~2.75 mmol/L、血磷0.97~1.61 mmol/L、ALP (男性45~125 U/L、女性50~135 U/L)、LDH 120~250 U/L。ALP为碱性磷酸酶,LDH为乳酸脱氢酶 表 3 骨转移瘤组与代谢性骨病组患者年龄、实验室检查结果的比较
Table 3. Comparison of age and laboratory examination results between patients with bone metastases and metabolic bone diseases
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由表4可知,骨转移瘤原发肿瘤中前列腺癌最常见,约占全部恶性肿瘤骨转移的56.3%(40/71),其次为乳腺癌,约占21.1%(15/71)。骨转移瘤组4个亚组患者的99Tcm-MDP SPECT全身骨显像显像模式及99Tcm-MDP SPECT/CT融合显像上骨质破坏类型的差异均无统计学意义(均P>0.05)。
组别 99Tcm-MDP SPECT 99Tcm-MDP SPECT/CT Ⅰ型 Ⅱ型 成骨型 溶骨型 混合型 前列腺癌组(n=40) 5(12.5%) 35(87.5%) 32(80.0%) 1(2.5%) 7(17.5%) 乳腺癌组(n=15) 1(6.7%) 14(93.3%) 9(60.0%) 2(13.3%) 4(26.7%) 肺癌组(n=8) 2(25.0%) 6(75.0%) 6(75.0%) 0 2(25.0%) 消化系统恶性肿瘤组(n=8) 2(25.0%) 6(75.0%) 6(75.0%) 1(12.5%) 1(12.5%) χ2值 2.71 5.12 P值 0.360 0.460 注:MDP为亚甲基二膦盐酸;SPECT为单光子发射计算机体层摄影术;CT为计算机体层摄影术 表 4 骨转移瘤组4个亚组患者的影像学特征的比较[例(%)]
Table 4. Comparison of imaging features among the four groups of bone metastases group (case (%))
由表5可知,骨转移瘤组4个亚组患者的主要临床表现和局部骨痛的差异均无统计学意义(均P>0.05)。由表6可知,骨转移瘤组4个亚组患者的年龄和实验室检查结果有所不同:乳腺癌患者年龄最小、前列腺癌患者年龄最大,乳腺癌患者血钙水平最高,肺癌患者LDH水平最高,4个亚组之间比较差异均有统计学意义(均P<0.05);4个亚组间血磷和ALP水平的差异均无统计学意义(均P>0.05)。
组别 临床表现 局部骨痛 全身骨痛 局部骨痛 无骨痛 腰痛 肋骨痛 四肢痛 其他 前列腺癌组(n=40) 3(7.5%) 24(60.0%) 13(32.5%) 15(62.5%) 0 6(25.0%) 3(12.5%) 乳腺癌组(n=15) 3(20.0%) 10(66.7%) 2(13.3%) 6(20.0%) 2(40.0%) 0(26.7%) 2(13.3%) 肺癌组(n=8) 0 4(50.0%) 4(50.0%) 1(25.0%) 1(25.0%) 0 2(50.0%) 消化系统恶性肿瘤组(n=8) 1(12.5%) 2(25.0%) 5(62.5%) 2(100%) 0 0 0 χ2值 8.71 13.07 P值 0.141 0.070 表 5 骨转移瘤组4个亚组患者临床表现和局部骨痛的比较[例(%)]
Table 5. Comparison of clinical manifestations and regional bone pain among the four groups of bone metastases group (case (%))
组别 年龄( , 岁)$\bar x \pm s $ 血钙( , mmol/L)$\bar x \pm s $ 血磷( , mmol/L)$\bar x \pm s $ ALP[M(Q1, Q3), U/L] LDH[M(Q1, Q3), U/L] 前列腺癌组(n=40) 70.80±8.11 2.10±0.17 1.01±0.24 620.00(308.00, 1080.00) 264.00(189.00, 590.00) 乳腺癌组(n =15) 51.73±8.45 2.31±0.20 1.19±0.25 289.00(178.75, 517.75) 414.50(228.25, 728.50) 肺癌组(n=8) 60.75±10.60 2.21±0.12 1.08±0.20 1030.00(227.00, 1473.00) 886.00(684.00, 1215.00) 消化系统恶性肿瘤组( n=8) 67.38±17.34 2.07±0.14 0.88±0.40 533.50(136.50, 933.50) 149.50(112.25, 539.75) 检验值 F=14.43 F=5.13 F=2.41 H=6.28 H=13.47 P值 <0.001 0.003 0.077 0.099 0.004 注:由于14例患者实验室检查指标的水平与显像时间相差较大,且骨转移瘤组患者中有1例无ALP、LDH,故均未进行统计学分析,行统计学分析的患者例数:血钙和血磷各57例、ALP和LDH各56例。实验室检查指标的正常参考值:血钙 2.25~2.75 mmol/L、血磷0.97~1.61 mmol/L、ALP (男性 45~125 U/L、女性 50~135 U/L)、LDH 120~250 U/L。ALP为碱性磷酸酶,LDH为乳酸脱氢酶 表 6 骨转移瘤组4个亚组患者年龄、实验室检查结果的比较
Table 6. Comparison of age and laboratory examination results among the four groups of bone metastases group
SPECT/CT超级骨显像影像学特征、临床表现、年龄及实验室检查指标的分析
Analysis of imaging features, clinical manifestations, age and laboratory examination indexes of SPECT/CT super bone scan
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摘要:
目的 探讨99Tcm-亚甲基二膦酸盐(MDP) SPECT/CT超级骨显像患者的影像学特征、临床表现、年龄及实验室检查结果的差异。 方法 收集2012年6月至2021年7月于宁夏医科大学总医院行99Tcm-MDP SPECT/CT显像的47 671例患者中呈超级骨显像的97例患者,其中男性54例、女性43例,年龄25~85(62.4±14.3)岁,回顾性分析97例患者的临床表现资料、影像学资料、年龄及实验室检查资料。根据病因不同,将患者分为骨转移瘤组(71例)与代谢性骨病组(26例,包括甲状旁腺瘤9例、肾性骨病6例、骨质疏松症11例)。根据原发肿瘤不同,将71例骨转移瘤组患者分为4个亚组[前列腺癌组(40例)、乳腺癌组(15例)、肺癌组(8例)、消化系统恶性肿瘤组(8例,包括胃癌4例、直肠癌2例、食管癌1例、原发性肝癌1例)]。统计分析骨转移瘤组与代谢性骨病组以及骨转移瘤组4个亚组之间99Tcm-MDP SPECT全身骨显像的特征、SPECT/CT融合显像的特征、临床表现、年龄和实验室检查[血钙、血磷、碱性磷酸酶(ALP)、乳酸脱氢酶(LDH)]结果的差异。计量资料的组间比较采用独立样本t检验、单因素方差分析、Wilcoxon秩和检验及Kruskal-Wallis H检验;分类变量资料的组间比较采用χ2检验。 结果 骨转移瘤(73.2%,71/97)是导致超级骨显像的最常见病因[在其原发肿瘤中,前列腺癌较常见(56.3%,40/71)],其次为代谢性骨病(26.8%,26/97)。骨转移瘤组以灶性散在分布型(Ⅱ型)为主(85.9%,61/71),代谢性骨病组主要呈均匀对称型( Ⅰ型)(61.5%,16/26),2组比较差异有统计学意义(χ2=21.84,P<0.001)。骨转移瘤组以成骨型(74.6%,53/71)和混合型(19.7%、14/71)骨质破坏为主,而代谢性骨病组以溶骨型(73.1%,19/26)骨质破坏为主,差异均有统计学意义(χ2=39.76、15.95,均P<0.001)。所有患者均以骨痛为初发症状,局部骨痛为主要临床表现(56.7%,55/97)。骨转移瘤组以腰痛最常见(60.0%,24/40),代谢性骨病组多为肋骨痛(40.0%,6/15),2组比较差异有统计学意义(χ2=11.11,P<0.05)。骨转移瘤组患者的年龄和ALP、LDH水平均高于代谢性骨病组,而血钙水平则低于代谢性骨病组,差异均有统计学意义(t=4.89,Z=−2.28、−3.65,t=−5.96,均P<0.05);而2组患者在血磷水平上的差异无统计学意义(t=0.01,P>0.05)。骨转移瘤组4个亚组在SPECT全身骨显像的显像模式、SPECT/CT融合显像中的骨质破坏类型、临床表现、局部骨痛部位间的差异均无统计学意义(χ2=2.71~13.07,均P>0.05) 。骨转移瘤组4个亚组间进行比较,乳腺癌组患者年龄最小、前列腺癌组患者年龄最大,乳腺癌组患者血钙水平最高,肺癌组患者LDH水平最高,且差异均有统计学意义(F=14.43、5.13,H=13.47,均P<0.05);血磷和ALP水平的差异均无统计学意义(F=2.41,H=6.28,均 P>0.05)。 结论 超级骨显像病因中以骨转移瘤最常见,其次为代谢性骨病。2种病因超级骨显像患者在99Tcm-MDP SPECT全身骨显像、病灶处99Tcm-MDP SPECT/CT融合显像、临床表现、年龄及实验室检查结果方面均有差异,99Tcm-MDP SPECT/CT在2种病因超级骨显像的鉴别中有一定价值。 -
关键词:
- 体层摄影术,发射型计算机,单光子 /
- 体层摄影术,X线计算机 /
- 99m锝美罗酸盐 /
- 骨肿瘤 /
- 肿瘤转移 /
- 超级骨显像
Abstract:Objective To explore the differences in the imaging features, clinical manifestations, age, and laboratory examination results of patients who underwent 99Tcm-methylenediphosphonate (MDP) SPECT/CT super bone scan. Methods A total of 97 patients with super bone scan, including 54 males and 43 females, aged 25–85 (62.4±14.3) years, were recruited from 47 671 patients who underwent 99Tcm-MDP SPECT/CT imaging in the General Hospital of Ningxia Medical University from June 2012 to July 2021. The clinical manifestation, imaging, age, and laboratory examination data of the 97 patients were retrospectively analyzed. In accordance with different etiologies, the patients were divided into the bone metastases group (71 cases) and the metabolic bone disease group (26 cases, including parathyroid adenoma (9 cases), renal bone disease (6 cases), and osteoporosis (11 cases)). In accordance with the location of the primary tumor, 71 patients with bone metastases were divided into four subgroups (prostate cancer group (40 cases); breast cancer group (15 cases); lung cancer group (8 cases); malignant digestive system tumors (8 cases), including gastric cancer (4 cases), rectal cancer (2 cases), esophageal cancer (1 case) and primary liver cancer (1 case)). The differences in 99Tcm-MDP SPECT whole-body bone scan and SPECT/CT fusion imaging features, clinical manifestations, age, and laboratory examination (serum calcium, serum phosphorus, alkaline phosphatase (ALP), and lactate dehydrogenase (LDH)) results between the bone metastasis group and the metabolic bone disease group and among the four subgroups of the bone metastasis group were statistically analyzed. Independent samples t-test, one-way ANOVA, Wilcoxon rank sum test, and Kruskal-Wallis H test were used to compare measurement data, and χ2 test was applied to compare classified variable data. Results Bone metastases (73.2%, 71/97) were the most common cause of super bone scan (among the primary tumors, prostate cancer was more common (56.3%, 40/71), followed by metabolic bone disease (26.8%, 26/97)). The bone metastasis group mainly exhibited focal scattered distribution type (type Ⅱ, 85.9%, 61/71), and the metabolic bone disease group presented mainly homogeneous and symmetrical type (type Ⅰ, 61.5%, 16/26), and the difference between the two groups was statistically significant (χ2=21.84, P<0.001). Osteogenic (74.6%, 53/71) and mixed types (19.7%, 14/71) were the main types of bone destruction in the bone metastases group, while osteolytic type (73.1%, 19/26) was the main type of bone destruction in the metabolic bone disease group, and the differences were statistically significant (χ2=39.76, 15.95; both P<0.001). In all patients, bone pain was the first symptom, and regional bone pain was the main clinical manifestation (56.7%, 55/97). Low back pain was the most common symptom in the bone metastasis group (60.0%, 24/40) and rib pain was the most common symptom in the metabolic bone disease group (40.0%, 6/15) with a significant difference between the two groups (χ2=11.11, P<0.05). Patients with bone metastasis had higher age, serum ALP and LDH levels and lower serum calcium levels than patients with metabolic osteopathy with statistically significant differences (t=4.89; Z=−2.28, −3.65; t=−5.96; all P<0.05). However, there was no significant difference in serum phosphorus levels between the two groups (t=0.01, P>0.05). No significant differences in the types of bone destruction, clinical manifestations, and local bone pain sites in SPECT whole-body bone scan and SPECT/CT fusion imaging were found among the four subgroups of the bone metastasis group (χ2=2.71–13.07; all P>0.05). Among the four subgroups of the bone metastasis group, the patients with breast cancer had the lowest age and the highest serum calcium levels, the patients with prostate cancer had the highest age, and the patients with lung cancer had the highest LDH levels, the differences were statistically significant (F=14.43, 5.13; H=13.47; all P<0.05). There were no significant differences in serum phosphorus and ALP levels (F=2.41; H=6.28; both P>0.05). Conclusions Bone metastases, followed by metabolic bone disease, are the most common causes for super bone scan. There were differences in 99Tcm-MDP SPECT whole body bone scan, focal 99Tcm-MDP SPECT/CT fusion imaging, clinical manifestation, age, and laboratory examination results in patiens with the two etiologies of super bone scan. 99Tcm-MDP SPECT/CT has a certain value in the identification of the two etiologies by super bone scan. -
表 1 骨转移瘤组与代谢性骨病组患者的影像学特征比较[例(%)]
Table 1. Comparison of imaging features between patients with bone metastases and metabolic bone disease (case(%))
组别 99Tcm-MDP SPECT 99Tcm-MDP SPECT/CT Ⅰ型 Ⅱ型 成骨型 溶骨型 混合型 骨转移瘤组(n=71) 10(14.1%) 61(85.9%) 53(74.6%) 4(5.7%) 14(19.7%) 代谢性骨病组(n=26) 16(61.5%) 10(38.5%) 5(19.2%) 19(73.1%) 2(7.7%) χ2值 21.84 43.74 P值 <0.001 <0.001 注:骨转移瘤组以成骨型和混合型骨质破坏为主,而代谢性骨病组以溶骨型骨质破坏为主,差异均有统计学意义(χ2=39.76、15.95,均 P<0.001)。MDP为亚甲基二膦酸盐;SPECT为单光子发射计算机体层摄影术;CT为计算机体层摄影术 表 2 骨转移瘤组与代谢性骨病组患者的临床表现和局部骨痛的比较[例(%)]
Table 2. Comparison of clinical manifestations and regional bone pain between patients with bone metastases and metabolic bone diseases (case(%))
组别 临床表现 局部骨痛 全身骨痛 局部骨痛 无骨痛 腰痛 肋骨痛 四肢痛 其他 骨转移瘤组(n=71) 7(9.9%) 40(56.3%) 24(33.8%) 24(60.0%) 3(7.5%) 6(15.0%) 7(17.5%) 代谢性骨病组(n=26) 5(19.2%) 15(57.7%) 6(23.1%) 3(20.0%) 6(40.0%) 4(26.7%) 2(13.3%) χ2值 2.09 10.88 P值 0.356 0.008 注:骨转移瘤组患者的局部骨痛主要为腰痛,而代谢性骨病组患者的局部骨痛主要为肋骨痛,差异有统计学意义(χ2=11.11,P=0.003) 表 3 骨转移瘤组与代谢性骨病组患者年龄、实验室检查结果的比较
Table 3. Comparison of age and laboratory examination results between patients with bone metastases and metabolic bone diseases
组别 年龄( , 岁)$\bar x \pm s $ 血钙( , mmol/L)$\bar x \pm s $ 血磷( , mmol/L)$\bar x \pm s $ ALP[M(Q1, Q3),U/L] LDH[M( Q1, Q3),U/L] 骨转移瘤组(n=71) 65.25±12.32 2.16±0.19 1.04±0.27 520.50(242.25, 1024.50) 338.00(193.50, 677.50) 代谢性骨病组(n=26) 50.85±14.26 2.59±0.35 1.04±0.67 284.35(138.65, 559.00) 172.00(111.25, 249.25) 检验值 t=4.89 t=−5.96 t=0.01 Z=−2.28 Z=−3.65 P值 <0.001 <0.001 0.990 0.023 <0.0001 注:由于14例患者实验室检查指标的水平与显像时间相差较大,且2组患者中有3例无ALP、LDH,故均未进行统计学分析,行统计学分析的患者例数:血钙和血磷各83例、ALP和LDH各80例。实验室检查指标的正常参考值:血钙2.25~2.75 mmol/L、血磷0.97~1.61 mmol/L、ALP (男性45~125 U/L、女性50~135 U/L)、LDH 120~250 U/L。ALP为碱性磷酸酶,LDH为乳酸脱氢酶 表 4 骨转移瘤组4个亚组患者的影像学特征的比较[例(%)]
Table 4. Comparison of imaging features among the four groups of bone metastases group (case (%))
组别 99Tcm-MDP SPECT 99Tcm-MDP SPECT/CT Ⅰ型 Ⅱ型 成骨型 溶骨型 混合型 前列腺癌组(n=40) 5(12.5%) 35(87.5%) 32(80.0%) 1(2.5%) 7(17.5%) 乳腺癌组(n=15) 1(6.7%) 14(93.3%) 9(60.0%) 2(13.3%) 4(26.7%) 肺癌组(n=8) 2(25.0%) 6(75.0%) 6(75.0%) 0 2(25.0%) 消化系统恶性肿瘤组(n=8) 2(25.0%) 6(75.0%) 6(75.0%) 1(12.5%) 1(12.5%) χ2值 2.71 5.12 P值 0.360 0.460 注:MDP为亚甲基二膦盐酸;SPECT为单光子发射计算机体层摄影术;CT为计算机体层摄影术 表 5 骨转移瘤组4个亚组患者临床表现和局部骨痛的比较[例(%)]
Table 5. Comparison of clinical manifestations and regional bone pain among the four groups of bone metastases group (case (%))
组别 临床表现 局部骨痛 全身骨痛 局部骨痛 无骨痛 腰痛 肋骨痛 四肢痛 其他 前列腺癌组(n=40) 3(7.5%) 24(60.0%) 13(32.5%) 15(62.5%) 0 6(25.0%) 3(12.5%) 乳腺癌组(n=15) 3(20.0%) 10(66.7%) 2(13.3%) 6(20.0%) 2(40.0%) 0(26.7%) 2(13.3%) 肺癌组(n=8) 0 4(50.0%) 4(50.0%) 1(25.0%) 1(25.0%) 0 2(50.0%) 消化系统恶性肿瘤组(n=8) 1(12.5%) 2(25.0%) 5(62.5%) 2(100%) 0 0 0 χ2值 8.71 13.07 P值 0.141 0.070 表 6 骨转移瘤组4个亚组患者年龄、实验室检查结果的比较
Table 6. Comparison of age and laboratory examination results among the four groups of bone metastases group
组别 年龄( , 岁)$\bar x \pm s $ 血钙( , mmol/L)$\bar x \pm s $ 血磷( , mmol/L)$\bar x \pm s $ ALP[M(Q1, Q3), U/L] LDH[M(Q1, Q3), U/L] 前列腺癌组(n=40) 70.80±8.11 2.10±0.17 1.01±0.24 620.00(308.00, 1080.00) 264.00(189.00, 590.00) 乳腺癌组(n =15) 51.73±8.45 2.31±0.20 1.19±0.25 289.00(178.75, 517.75) 414.50(228.25, 728.50) 肺癌组(n=8) 60.75±10.60 2.21±0.12 1.08±0.20 1030.00(227.00, 1473.00) 886.00(684.00, 1215.00) 消化系统恶性肿瘤组( n=8) 67.38±17.34 2.07±0.14 0.88±0.40 533.50(136.50, 933.50) 149.50(112.25, 539.75) 检验值 F=14.43 F=5.13 F=2.41 H=6.28 H=13.47 P值 <0.001 0.003 0.077 0.099 0.004 注:由于14例患者实验室检查指标的水平与显像时间相差较大,且骨转移瘤组患者中有1例无ALP、LDH,故均未进行统计学分析,行统计学分析的患者例数:血钙和血磷各57例、ALP和LDH各56例。实验室检查指标的正常参考值:血钙 2.25~2.75 mmol/L、血磷0.97~1.61 mmol/L、ALP (男性 45~125 U/L、女性 50~135 U/L)、LDH 120~250 U/L。ALP为碱性磷酸酶,LDH为乳酸脱氢酶 -
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