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(18)F-FDG PET/CT在接受托珠单抗作为一线治疗的风湿性多肌痛患者治疗评估中的价值

Value of (18)F-FDG PET/CT for therapeutic assessment of patients with polymyalgia rheumatica receiving tocilizumab as first-line treatment.

作者信息

Palard-Novello X, Querellou S, Gouillou M, Saraux A, Marhadour T, Garrigues F, Abgral R, Salaün P Y, Devauchelle-Pensec V

机构信息

Department of Nuclear Medicine, Brest University Hospital, 2 Avenue FOCH, 26609, Brest Cedex, France.

EA3878, GETBO, IFR148, Brest University, Brest, France.

出版信息

Eur J Nucl Med Mol Imaging. 2016 Apr;43(4):773-9. doi: 10.1007/s00259-015-3287-z. Epub 2016 Jan 11.

Abstract

PURPOSE

To evaluate the use of (18)F-FDG PET/CT for the assessment of tocilizumab (TCZ) as first-line treatment in patients with polymyalgia rheumatica (PMR).

METHODS

Patients with PMR were prospectively enrolled in a multicentre clinical trial assessing TCZ therapy (the TENOR trial). The patients underwent FDG PET/CT at baseline, after the first infusion of TCZ (TCZ 1) and after the last infusion of TCZ (TCZ 3). Responses to treatment were evaluated in terms of the PMR activity score (PMR-AS), and the C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) laboratory tests. Maximal standardized uptake value (SUVmax) was used for assessment of FDG uptake in regions usually affected in PMR (spinous processes, hips, shoulders, sternoclavicular region and ischial tuberosities). The Wilcoxon test was applied to evaluate the changes in parameters after the infusions and Spearman's rank correlation test was applied to assess the correlations between SUVmax and PMR-AS, CRP and ESR.

RESULTS

Of 21 patients included in the trial, 18 were evaluated. The median bioclinical parameter values decreased after TCZ 1 (PMR-AS from 38.2 to 15.7, CRP from 65.2 to 0.4 mg/l and ESR from 49 to 6.5 mm; all p < 0.05) as did the median SUVmax (from 5.8 to 5.2; p < 0.05). All values also decreased after TCZ 3 (PMR-AS from 38.2 to 3.9, CRP from 65.2 to 0.2, ESR from 49 to 2, and SUVmax from 5.8 to 4.7; p < 0.05). In a region-based analysis, all SUVmax were significantly reduced after TCZ 3, except the values for the cervical spinous processes and shoulder regions. With regard to correlations, few significant differences were found between ∆SUVmax and the other parameters including ∆PMR-AS, ∆CRP and ∆ESR in the patient-based and region-based analysis.

CONCLUSION

FDG uptake decreased significantly but moderately after TCZ therapy in PMR patients, and might reflect disease activity.

摘要

目的

评估¹⁸F - FDG PET/CT在评估托珠单抗(TCZ)作为风湿性多肌痛(PMR)患者一线治疗中的应用。

方法

PMR患者前瞻性纳入一项评估TCZ治疗的多中心临床试验(TENOR试验)。患者在基线、首次输注TCZ后(TCZ 1)和末次输注TCZ后(TCZ 3)接受FDG PET/CT检查。根据PMR活动评分(PMR - AS)、C反应蛋白(CRP)和红细胞沉降率(ESR)实验室检查评估治疗反应。最大标准化摄取值(SUVmax)用于评估PMR通常受累区域(棘突、髋部、肩部、胸锁关节区域和坐骨结节)的FDG摄取。采用Wilcoxon检验评估输注后参数的变化,采用Spearman秩相关检验评估SUVmax与PMR - AS、CRP和ESR之间的相关性。

结果

试验纳入的21例患者中,18例进行了评估。TCZ 1后生物临床参数中位数下降(PMR - AS从38.2降至15.7,CRP从65.2降至0.4 mg/L,ESR从49降至6.5 mm;均p < 0.05),SUVmax中位数也下降(从5.8降至5.2;p < 0.05)。TCZ 3后所有值也下降(PMR - AS从38.2降至3.9,CRP从65.2降至0.2,ESR从49降至2,SUVmax从5.8降至4.7;p < 0.05)。在基于区域的分析中,除颈椎棘突和肩部区域的值外,TCZ 3后所有SUVmax均显著降低。关于相关性,在基于患者和基于区域的分析中,∆SUVmax与包括∆PMR - AS、∆CRP和∆ESR在内的其他参数之间几乎没有发现显著差异。

结论

PMR患者接受TCZ治疗后,FDG摄取显著但适度下降,可能反映疾病活动。

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