核医学是现代医学中的一个重要分支,是涉及多门学科的综合性学科,提高核医学的临床教学水平已受到越来越多的重视.本文从医学教育模式的角度,就循证医学思维结合人文思政教育对传统核医学教学模式进行改革加以探讨,以便在核医学教学实践中应用,更好地培养学生的学习兴趣、自学能力及临床思维,培养高素质的核医学人才.

目的:探讨放射性核素骨显像诊断人工关节置换后假体感染.方法:选择26例的人工关节感染患者,分为观察组和对照组,观察组进行放射性核素骨显像诊断,对照组进行CT检查,比较两组患者在实施人工关节置换后假体的不同程度的感染率、假体感染敏感性和特异性,以及对假体下沉、骨溶解等表现的检出情况.结果:观察组人工关节置换后的假体感染检出率显著高于对照组(P<0.05);敏感性、特异性、阳性预测值和阴性预测值等指标显著高于对照组(P<0.05);观察组不易鉴别假体下沉、骨溶解、骨膜反应、内固定不稳等表现,对照组却能分辨.结论:采用放射性核素骨显像诊断人工关节感染,具有较高的假体感染检出率,敏感性、特异性、阳性预测值和阴性预测值等感染特异性普遍较高,虽然在检出假体下沉、骨溶解等方面不如CT检查,在诊断人工关节感染中有着不可代替的作用.

目的 探讨6 h99m Tc-二乙基乙酰苯胺亚氨二醋酸(EHIDA)肝胆静态显像半定量分析法联合血清谷氨酰转肽酶(GGT)对婴儿先天性肝外胆道闭锁(EHBA)的诊断价值.方法 选取行手术治疗的持续性黄疸患儿159例,根据手术评价结合病理诊断分为EHBA组82例、婴儿肝炎综合征(IHS)组77例.检测两组血清GGT,并行99m Tc-EHIDA肝胆动态显像,计算6 h肝胆平面显像半定量法指标肠本差值(即6 h肠本差值).比较两组间GGT水平、6 h肠本差值,绘制各自受试者工作特征(ROC)曲线,并分别确定诊断EHBA的阈值.同时比较GGT水平、6 h肠本差值及6 h肠本差值与GGT联用(即联合诊断)对EHBA的诊断效能.结果 两组间血清GGT水平、6 h肠本差值比较差异有统计学意义(P均<0.05),GGT水平和6 h肠本差值诊断EHBA的效能均较高[ROC曲线下面积(AUC)分别为0.895、0.753].6 h肠本差值诊断EHBA的灵敏度、特异性、准确性、阳性预测值分别为86.59%(71/82)、50.65%(39/77)、69.18%(110/159)、65.14%(71/109);GGT的相应参数分别为74.39%(61/82)、90.91%(70/77)、82.39%(131/159)、89.71%(61/68).6 h肠本差值的灵敏度优于GGT值(χ2=3.883,P<0.05),但特异性、准确性和阳性预测值低于GGT值(χ2分别为30.172、7.557和13.331,P均<0.01).联合诊断与单用6 h肠本差值相比,诊断EHBA的特异性、准确性、阳性预测值提高(χ2分别为35.136、21.058和20.078,P均<0.05),分别达93.51%(72/77)、89.94%(143/159)和93.42%(71/76).结论 6 h肝胆静态显像半定量法联合血清GGT可提高对EHBA诊断的特异性和准确性.

Objective To investigate the diagnostic value of the residual ratio and the ratio of 99Tcm-pertechnetate uptake at 10 min (UR10min) in patients with Sj(o)gren's syndrome (SS).Methods The retrospective study included 94 cases of SS (9 males,85 females;average age (48±13) years) and 60 cases of non-SS (control group;14 males,46 females,average age (46±13) years).All patients underwent 99Tcm-pertechnetate salivary gland scintigraphy.According to the uptake of 99Tcm-pertechnetate in parotid gland,94 SS patients were divided into 3 groups:group A including 15 normal cases and 7 cases with mild injury,group B including 56 cases with moderate injury,and group C including 16 cases with severe injury.ROI was drawn,then UR10 min and the residual ratio of 99Tcm-pertechnetate in parotid gland were calculated.Oneway analysis of variance,q test and ROC curve analysis were used.Results UR10 min in control group,group A and group B(1.48±0.43,1.56±0.38,1.38±0.55,respectively) was significantly higher than that of group C (0.53±0.21;F=20.3,q values:15.8,7.9,8.5,all P＜0.05).The residual ratio of parotid gland in control group(0.63±0.08) was significantly lower than those of the SS patients in the 3 groups (0.83±0.14,1.14±0.08,1.09±0.08 respectively,F=315.0,q values:14.3,41.0,32.8,all P＜0.05).The residual ratio in group A was lower than that in group B and group C(q values:31.0,13.0,both P＜0.05).The AUC of ROC curve was 0.62 for UR10 min and 0.97 for residual ratio.Conclusions The UR10 min of parotid gland is sensitive for the diagnosis of the advanced SS,while the residual ratio is sensitive for the diagnosis of the early SS.Residual ratio could be a quantitative parameter to detect the function of parotid gland.

目的 探讨碘131治疗重度甲亢患者的临床疗效与安全性.方法 对2003年1月至2007年12月广西医科大学第一附属医院核医学科收治的180例重度甲亢患者采用碘131进行治疗并随访观察1～5年.结果 180例重度甲亢的患者应用碘131治疗一次治愈率为83.33％;早发甲低发生率为6.7％,永久性甲低发生率为5.56％;平均治愈时间6.8个月.结论 碘131治疗重度甲亢能最大限度缩短病程,安全有效,无明显副作用,可作为首选治疗方法.

目的:探讨99mTcO4-甲状腺显像诊断儿童异位甲状腺的临床价值.方法:对28例临床拟排除异位甲状腺患儿行99mTcO4-甲状腺显像,并与病理结果比较.结果:28例中有10例舌根部肿物,8例颈前肿物及4例颏下肿物患儿在颈前甲状腺正常部位无放射性分布,肿物部位可见明显类圆形放射性浓聚,细胞学穿刺均证实为异位甲状腺.其余6例在甲状腺正常部位可见甲状腺显影清晰,形态、大小正常,肿物无摄99mTcO4-功能,经细胞学穿刺及手术病理证实肿物非异位甲状腺.结论:99mTcO4-甲状腺显像在诊断儿童异位甲状腺中具有独特的临床价值,对临床治疗决策起着重要的指导作用.

目的 探讨摄131Ⅰ率峰值出现时间及碘转换率与有效半衰期之间关系,寻找一种简便有效的半衰期推算方法.方法 测定187例Graves病患者3、6、9及24 h摄131Ⅰ率和有效半衰期.对3、6、9h与24 h摄131Ⅰ率比值行方差分析,并与有效半衰期行相关回归分析.结果 3 h/24 h、6h/24 h和9 h/24 h碘转换率两两比较,P均＜0.01；其中6 h/24 h碘转换率与有效半衰期相关程度最大,并有直线相关关系(F=56.521,P=0.000).结论 6h/24 h碘转换率与有效半衰期相关程度比3 h/24 h和9 h/24 h大,并有直线相关关系,可以初步根据直线回归方程推算有效半衰期的具体数值和9h摄131Ⅰ率值,更早更准的指导及调整131Ⅰ治疗Graves病的剂量.

Objective To study the characteristics of multiple myeloma(MM) in ~(99m)Tc-MDP bone scanning, investigating the applied value of ~(99m)Tc-MDP bone scanning in diagnosis of the MM.Methods The findings of 42 patients with MM who underwent ~(99m)Tc-MDP bone scanning were analyzed.Results ~(99m)Tc-MDP bone scanning of 34 patients were abnormal in the 42 patients with MM,the masculine rate was 80.5%,lesions were multiple.Most of imaging showed the focal areas of increased uptake.Little of imaging showed the co-existence of focal areas of increased uptake and decreased uptake.Most of the lesions were detected in rib,spine,pelvis and limbs.Multiple uptake increase like a dot or string of pearls was often seen in ribs.Most of the lesions in spine showed as flat hot areas. The lesions in pelvis and spine showed as doughnut sign.The lesions in skull showed the extensive areas of increased uptake like a cap.Conclusion There are some characteristics in ~(99m)Tc-MDP bone scanning with MM. ~(99m)Tc-MDP bone scanning can be considered as one of routine examination for detecting bone lesions for patients with MM.

目的探讨血清促甲状腺激素受体抗体（TRAb）水平在Graves病（GD）患者131I治疗后早发甲状腺功能减低（甲减）发生中的作用,为临床随访监测提供依据。方法将123例GD患者按治疗前血清TRAb水平分为TRAb阳性组（TRAb＞15 IU/mL）和TRAb阴性组（TRAb≤15 IU/mL）,分别于131I治疗前及治疗后3、6、12个月测定血清游离三碘甲状腺原氨酸（FT3）、游离四碘甲状腺原氨酸（FT4）、促甲状腺激素（TSH）水平,并判定早发甲减发生情况。结果 TRAb阳性组和TRAb阴性组早发甲减率分别为54.72%（29/53）、31.43%（22/70）,两组比较P＜0.05。结论血清TRAb水平在GD患者131I治疗后早发甲减发生中起重要作用,临床可据此采取相关防治措施。

目的 探讨Graves病患者早期碘代谢情况,寻找一种能简便、准确测定甲状腺摄131I率峰值的方法.方法 162例Graves病患者,口服131I后3 h、6 h、9 h及24 h测定甲状腺摄131I率,计算3 h/24 h、6 h/24 h、9 h/24 h(分别记为A、B、C组)甲状腺摄131I率比值(即3 h、6 h和9 h甲状腺摄131I率分别与24 h甲状腺摄131I率的比值).结果 口服131I后3 h、6 h、9 h及24 h甲状腺摄131I率分别为(51.23±18.01)%、(61.95±16.72)%、(64.99±16.18)%、(65.47±14.75)%.A、B、C组甲状腺摄131I率比值分别为(0.77±0.21)、(0.94±0.15)、(0.99±0.12),3组甲状腺摄131I率比值差异有统计学意义(P＜0.05),其中C组甲状腺摄131I率比值较A、B组高(P＜0.05).A、B、C组甲状腺摄131I率比值≥1.00者分别占11.73%(19/162)、30.25%(49/162)、41.36%(67/162).结论 9 h甲状腺摄131I率较接近24 h甲状腺摄131I率,9 h/24 h甲状腺摄131I率比值较3 h/24 h、6 h/24 h甲状腺摄131I率比值对131I治疗Graves病更有指导意义.

目的:探讨Graves病患者6 h/24 h摄131I率比值与其性别、年龄、甲状腺肿大程度、TT3、TT4、FT3和FT4的相关性,找出6 h/24 h摄131I率比值的影响因素并作为计算131I治疗Graves病剂量的参考依据.方法:测定160例Graves病患者6,24 h摄131I率、TT3、TT4、FT3和FT4.应用SPSS13.0软件对6 h/24 h摄131I率比值与其临床相关指标进行相关分析.结果:在单因素分析中6 h/24 h摄131I率比值与性别、甲状腺肿大程度、TT3、TT4、FT3和FT4呈正相关关系,与年龄呈负相关关系,多元逐步分析提示6 h/24 h摄131I率比值与FT3呈正相关关系,与年龄呈负相关关系.结论:131I治疗FT3水平较高的Graves病患者需增加治疗剂量.

目的探讨99mTc-MDP全身骨显像在原因不明骨痛患者诊断中的价值。方法对143例原因不明的骨痛患者进行99mTc-MDP全身骨显像,分析其影像表现特点。结果 143例全身骨显像中阳性118例(82.5%),除原发恶性骨肿瘤、骨结核外,病灶以多发为主。77例骨转移瘤病人中全身骨显像阳性70例(90.9%),病灶表现为非对称性、不规则放射性核素异常浓聚,分布以中轴骨受累最常见。原发恶性骨肿瘤病灶主要分布于四肢及胸、腰椎,多呈团块状放射性核素异常浓聚,偶见放射性稀疏、缺损。多发性骨髓瘤病灶多分布于肋骨、椎体,大部分表现为放射性核素异常浓聚,少数表现为核素稀疏或缺损合并浓聚,呈"面圈样"改变,颅骨较少累及。骨结核病灶主要分布于脊柱及骨盆,四肢、肋骨及颅骨均未累及,放射性核素异常浓聚及缺损并存。骨良性病变病人可见胸椎、腰椎及骨盆多发病灶,放射性分布不均匀,形态不规则。结论99mTc-MDP全身骨显像可较早期发现骨骼异常,尤其对转移瘤的早期诊断有较高的临床价值,应作为原因不明骨痛患者常规首选检查手段。

目的探讨摄131I率峰值出现时间及碘转换率与有效半衰期之间关系,寻找一种简便有效的半衰期推算方法。方法测定187例Graves病患者3、6、9及24 h摄131I率和有效半衰期。对3、6、9 h与24 h摄131I率比值行方差分析,并与有效半衰期行相关回归分析。结果 3 h/24 h、6 h/24 h和9 h/24 h碘转换率两两比较,P均<0.01;其中6 h/24 h碘转换率与有效半衰期相关程度最大,并有直线相关关系(F=56.521,P=0.000)。结论 6h/24 h碘转换率与有效半衰期相关程度比3 h/24 h和9 h/24 h大,并有直线相关关系,可以初步根据直线回归方程推算有效半衰期的具体数值和9 h摄131I率值,更早更准的指导及调整131I治疗Graves病的剂量。

Objective To study the correlation between the drift rate of serum Thl/Th2 and thyroid I conversion rate in patients with Graves disease. Methods Sixty patients with Graves disease ( GD group) and thirty healthy people (control group) were selected and compared. In this study, IL-2 represented cytokines of Thl, IL-6 represented cytokines of Th2. Results IL-6 in GD group was obviously higher than that in the control group (P < 0. 01) ;IL- 2 in GD group was obviously lower than that in the control group (P <0. 01) ; There was no correlation between IL-2、IL-6、IL-2/IL-6 and ~(131)I conversion rate. Conclusion The imbalance of Thl/Th2 cytokines in patients with GD was in favour of Th2. There was no correlation between the drift rate of Thl/Th2 cytokines and thyroid I conversion rate.

Objective To investigate the effect of different levels of serum FT3 concentration on the turnover rate of radioiodine. Methods The serum concentration of FT3 and the uptake of radioiodine at 3 h and 24 h in 438 Graves hyperthyroidism patients were mesured. All the patients were divided into three groups by different FT3 levels and classified into four degrees by different levels of the turnover rate of radioiodine. Results The turnover rate of radioiodine showed statistically significant between the three groups (P < 0. 05 ). Conclusion Different levels of serum FT3 concentration have different effect on the turnover rate of radioiodine, the levels of serum FT3 concentration can be used for estimating the level of the turnover rate of radioiodine.

目的探讨核素全身骨显像在结直肠癌骨转移中的显像特点及临床价值。方法对285例经手术及病理确诊的结直肠癌患者行99mTc-亚甲基二磷酸盐(MDP)核素全身骨显像,并对骨转移数量、部位及合并其他远处部位转移、血清癌胚抗原(CEA)、碱性磷磷酸酶(ALP)等指标进行分析。结果结直肠癌骨转移率10.5%,少发(1～2个)病灶与多发病灶相当,好发部位为腰骶椎以下部位,多合并其他部位如肝、肺、淋巴结等转移,CEA、ALP对骨转移的敏感性不高。结论全身骨显像对结直肠的分期及预后有价值。