Hosokawa Takahiro, Uchiyama Mayuki, Namba Sakie, Tanami Yutaka, Sato Yumiko, Wakabayashi Yasuharu, Oguma Eiji
Department of Radiology, Saitama Children's Medical Center, 1-2 Shintoshin Chuo-Ku Saitama, Saitama, 330-8777, Japan.
Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan.
Ann Nucl Med. 2025 Sep 22. doi: 10.1007/s12149-025-02109-5.
This study aimed to demonstrate the differences in Technetium-99 m albumin scintigraphy findings for patients with protein-losing enteropathy (PLE) associated with their characteristics and laboratory data.
Eighteen patients with PLE were grouped into two based on two mechanisms: direct mucosal damage and failed lymph drainage. Scintigraphy images were divided based on the timing of acquisition: images obtained at 1, 2, 4, 6, and 24 h after starting the examination. The intensity of tracer uptake was graded as follows: 3 (marked uptake equal to or greater than the liver level), 2 (moderate uptake less than liver and greater than kidney levels), 1 (mild uptake less than kidney level), and 0 (negative). The grades at each timepoint for the two groups were compared using the Mann-Whitney U test. The associations between the grades and fecal alpha-1-antitrypsin and serum total protein concentrations were evaluated using Pearson correlation coefficients.
Of 18 patients, 7 had PLE due to failed lymph drainage. The direct mucosal damage and failed lymph drainage groups had significantly different fecal alpha-1-antitrypsin concentrations [43.5 ± 29.6 (range 11-115) vs. 208.7 ± 66.0 (range 124-311), respectively; P < 0.001] and scintigraphy-based severity at 24 h [1.2 ± 0.8 (range 1-3) vs. 2.8 ± 0.4 (range 2-3), respectively; P = 0.007]. The fecal alpha-1-antitrypsin concentration was positively correlated with the scintigraphy-based severity at 6 h (r = 0.499, P = 0.049) and 24 h (r = 0.747, P = 0.002). However, the serum protein concentration was negatively correlated with the scintigraphy-based severity at 6 h (r = - 0.587, P = 0.017).
The scintigraphy-based severity at 6 and 24 h and the fecal alpha-1-antitrypsin concentrations were higher for patients with PLE due to failed lymph drainage mechanisms than for those with PLE due to direct mucosal damage. Scintigraphy can help localize the leakage point and determine disease severity to guide PLE management.
本研究旨在阐明99m锝白蛋白闪烁扫描检查结果在蛋白丢失性肠病（PLE）患者中的差异，并分析其与患者特征及实验室数据之间的关系。
18例PLE患者根据两种机制分为两组：直接黏膜损伤和淋巴引流障碍。闪烁扫描图像根据采集时间进行划分：检查开始后1、2、4、6和24小时获得的图像。示踪剂摄取强度分级如下：3级（摄取明显，等于或高于肝脏水平），2级（摄取中等，低于肝脏水平但高于肾脏水平），1级（摄取轻度，低于肾脏水平），0级（阴性）。两组在每个时间点的分级采用Mann-Whitney U检验进行比较。使用Pearson相关系数评估分级与粪便α-1抗胰蛋白酶及血清总蛋白浓度之间的相关性。
18例患者中，7例因淋巴引流障碍导致PLE。直接黏膜损伤组和淋巴引流障碍组的粪便α-1抗胰蛋白酶浓度有显著差异[分别为43.5±29.6（范围11 - 115）和208.7±66.0（范围124 - 311）；P<0.001]，且24小时基于闪烁扫描的严重程度也有显著差异[分别为1.2±0.8（范围1 - 3）和2.8±0.4（范围2 - 3）；P = 0.007]。粪便α-1抗胰蛋白酶浓度与6小时（r = 0.499，P = 0.049）和24小时（r = 0.747，P = 0.002）基于闪烁扫描的严重程度呈正相关。然而，血清蛋白浓度与6小时基于闪烁扫描的严重程度呈负相关（r = -0.587，P = 0.017）。
因淋巴引流障碍机制导致PLE的患者，其6小时和24小时基于闪烁扫描的严重程度以及粪便α-1抗胰蛋白酶浓度高于因直接黏膜损伤导致PLE的患者。闪烁扫描有助于定位渗漏点并确定疾病严重程度，以指导PLE的管理。
