Liu Shih-Feng, Liu Jien-Wei, Lin Meng-Chih, Lee Chiang-Hsuan, Huang Hsu-Hua, Lai Yung-Fa
Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan, ROC.
AJR Am J Roentgenol. 2007 May;188(5):W403-8. doi: 10.2214/AJR.06.0587.
Gallium-67 scintigraphy is more sensitive than chest radiography in a single concurrent detection of pulmonary tuberculosis (TB). As for inflammation, the intensity of pulmonary uptake of 67Ga citrate theoretically is a function of the inflammation level in the lung. To maximize clinical applicability of 67Ga scintigraphy in the evaluation of pulmonary TB, we prospectively assessed serial qualitative associations between intensity of the uptake of 67Ga citrate and the severity of lung inflammation, reflected by the burden of Mycobacterium tuberculosis in the sputum of patients undergoing anti-TB chemotherapy.
Each enrolled patient had chest radiographic, microbiologic, 67Ga imaging, and semiquantitation of sputum acid-fast bacillus (AFB) assessments before and at the third and sixth months after receiving anti-TB chemotherapy. The burden of pulmonary M. tuberculosis (presumably, in proportion to the semiquantitation of AFB in sputum) and the intensity of 67Ga citrate uptake in the lung at each synchronized assessment were regarded as a paired variable. Odds ratios were obtained from odds (derived using generalized estimating equations) in favor of higher pulmonary 67Ga uptake in differing scores of semiquantitation of sputum AFB. Linear trend for pulmonary 67Ga citrate uptake corresponding to varied pulmonary M. tuberculosis burdens was assessed using contrast analysis of their odds ratios.
Thirty patients (24 men and six women) with pulmonary TB were enrolled. Eighty-six paired semiquantitations of sputum AFB-67Ga-scintigraphic studies were collected. Twenty-six patients were cured of their pulmonary TB. The pulmonary 67Ga uptake increased in proportion to the higher score of semiquantitation of sputum AFB (p = 0.009, for trend).
In patients with pulmonary TB, the higher the burden of M. tuberculosis in the lung, the higher the intensity of pulmonary 67Ga citrate uptake. Serial 67Ga-scintigraphy examinations are helpful in evaluations of the effectiveness of anti-TB therapy when assessments based on chest radiography are difficult.
在肺结核（TB）的单次同步检测中，镓-67闪烁扫描比胸部X线摄影更敏感。至于炎症，理论上67Ga柠檬酸盐在肺部的摄取强度是肺部炎症水平的函数。为了最大限度地提高67Ga闪烁扫描在肺结核评估中的临床适用性，我们前瞻性地评估了67Ga柠檬酸盐摄取强度与肺部炎症严重程度之间的系列定性关联，肺部炎症严重程度通过接受抗结核化疗患者痰液中结核分枝杆菌的负荷来反映。
每位入选患者在接受抗结核化疗前、化疗后第三个月和第六个月均进行胸部X线摄影、微生物学检查、67Ga成像以及痰液抗酸杆菌（AFB）半定量评估。每次同步评估时，肺部结核分枝杆菌的负荷（推测与痰液中AFB的半定量成比例）和肺部67Ga柠檬酸盐摄取强度被视为配对变量。优势比从支持痰液AFB不同半定量分数下肺部67Ga摄取更高的优势（使用广义估计方程得出）中获得。使用优势比的对比分析评估与不同肺部结核分枝杆菌负荷相对应的肺部67Ga柠檬酸盐摄取的线性趋势。
纳入30例肺结核患者（24例男性和6例女性）。收集了86对痰液AFB-67Ga闪烁扫描研究的半定量数据。26例患者的肺结核得到治愈。肺部67Ga摄取随着痰液AFB半定量分数的升高而增加（趋势p = 0.009）。
在肺结核患者中，肺部结核分枝杆菌的负荷越高，肺部67Ga柠檬酸盐摄取强度越高。当基于胸部X线摄影的评估困难时，系列67Ga闪烁扫描检查有助于评估抗结核治疗的效果。
