Santagati Giulia, Cataldo Emanuela, Columbano Valeria, Chatrenet Antoine, Penna Daniele, Pelosi Ettore, Hachemi Mammar, Gendrot Lurlinys, Nielsen Louise, Cinquantini Francesco, Saulnier Patrick, Arena Vincenzo, Boursot Charles, Piccoli Giorgina Barbara
Néphrologie, Centre Hospitalier du Mans, 72037 Le Mans, France.
Affidea IRMET, PET CENTER, Torino via Onorato Vigliani 89, 10135 Torino, Italy.
J Clin Med. 2019 Sep 19;8(9):1494. doi: 10.3390/jcm8091494.
The improvements in dialysis have not eliminated long-term problems, including dialysis-related amyloidosis (DRA), caused by Beta-2 microglobulin deposition. Several types of scintigraphy have been tested to detect DRA, none entered the clinical practice. Aim of the study was to assess the potential of PET-FDG scan in the diagnosis of DRA.
Forty-six dialysis patients with at least one PET scan (72 scans) were selected out 162 patients treated in 2016-2018. Subjective global assessment (SGA), malnutrition inflammation score (A), Charlson Comorbidity Index (CCI), were assessed at time of scan; 218 age-matched cases with normal kidney function were selected as controls. PET scans were read in duplicate. Carpal tunnel syndrome was considered a proxy for DRA. A composite "amyloid score" score considered each dialysis year = 1 point; carpal tunnel-DRA = 5 points per site. Logistic regression, ROC curves and a prediction model were built.
The prevalence of positive PET was 43.5% in dialysis, 5% in controls ( < 0.0001). PET was positive in 14/15 (93.3%) scans in patients with carpal tunnel. PET sensitivity for detecting DRA was 95% (specificity 64%). Carpal tunnel was related to dialysis vintage and MIS. A positive PET scan was significantly associated with dialysis vintage, MIS and amyloid score. A prediction model to explain PET positivity combined clinical score and MIS, allowing for an AUC of 0.906 (CI: 0.813-0.962; < 0.001).
PET-FDG may identify DRA, and may be useful in detecting cases in which inflammation favours B2M deposition. This finding, needing large-scale confirmation, could open new perspectives in the study of DRA.
透析技术的改进并未消除由β2微球蛋白沉积引起的包括透析相关淀粉样变性（DRA）在内的长期问题。已经对几种类型的闪烁扫描术进行了检测以发现DRA，但均未进入临床应用。本研究的目的是评估PET-FDG扫描在DRA诊断中的潜力。
从2016年至2018年接受治疗的162例患者中选出46例至少进行过一次PET扫描的透析患者（共72次扫描）。在扫描时评估主观全面评定法（SGA）、营养不良炎症评分（A）、查尔森合并症指数（CCI）；选取218例年龄匹配的肾功能正常的病例作为对照。PET扫描由两人分别解读。腕管综合征被视为DRA的替代指标。综合“淀粉样变评分”为每个透析年份计1分；腕管-DRA每个部位计5分。构建逻辑回归、ROC曲线和预测模型。
透析患者中PET阳性的患病率为43.5%，对照组为5%（P<0.0001）。腕管综合征患者的15次扫描中有14次（93.3%）PET呈阳性。PET检测DRA的敏感性为95%（特异性为64%）。腕管综合征与透析龄和营养不良炎症评分相关。PET扫描阳性与透析龄、营养不良炎症评分和淀粉样变评分显著相关。一个用于解释PET阳性的预测模型结合了临床评分和营养不良炎症评分，曲线下面积为0.906（95%CI：0.813-0.962；P<0.001）。
PET-FDG可能识别DRA，并且可能有助于检测炎症促进β2微球蛋白沉积的病例。这一发现需要大规模验证，可能为DRA的研究开辟新的前景。
