Toftdahl D B, Højgaard L, Winkler K
Department of Medical Gastroenterology, Hvidovre Hospital, University of Copenhagen, Denmark.
J Nucl Med. 1996 Feb;37(2):261-6.
The main purposes of this study were to investigate the best parameter for describing gallbladder emptying and whether gallbladder bile emptying should be induced with a bolus injection or continuous infusion of cholecystokinin-octapeptide (CCK-8).
Gallbladder emptying was measured by dynamic cholescintigraphy. Twelve healthy subjects and six patients with gallstones were examined twice with CCK-8 infusion cholescintigraphy, 0.3 ng CCK-8 kg per min for 60 min under identical circumstances. Another six healthy subjects randomly received bolus injection (0.04 microgram/kg) and infusion of CCK-8 (0.3 ng/kg per min for 60 min), respectively, during cholescintigraphy on two separate occasions. The choice of bolus dose was based on recommendations from the CCK-8 manufacturer. The infusion dose was chosen to produce plasma CCK concentrations similar to postprandial plasma CCK levels.
A parameter of gallbladder emptying, mean ejection fraction (EF), was defined as 100% minus the area under the time-activity curve normalized to 100% and divided by the time interval from maximum to minimum counts per minute. This parameter proved superior to the well known parameters, EFmax. and EF30, in regard to reproducibility in healthy subjects. The slope of the regression line for the mean EF was 0.998 and the intercept value approximately 0% (p = 0.0001). The mean coefficient of variation was 4%. Apart from a higher mean coefficient of variation, similar reproducibility results were seen in the six patients. The measurements of EF30 in healthy subjects scattered more widely around the mean compared to the mean EF and EFmax, which indicates poorer ability to separate normal from abnormal gallbladder emptying. Intravenous bolus injection of CCK-8 resulted in incomplete gallbladder emptying with a mean EF value of 16% (s.d. 9%; range 7%-32%) compared to 49% (s.d. 7%; range 37%-57%) following CCK-8 infusion (p = 0.004). Abdominal discomfort was observed in all subjects after administration of the bolus injection, whereas no complaints were reported during infusion.
Mean EF is the best parameter for describing gallbladder emptying. Moreover, slow infusion of a physiological dose of CCK-8 is preferable to induce gallbladder emptying because it results in more complete emptying and has no side effects.
本研究的主要目的是探究描述胆囊排空的最佳参数，以及胆囊胆汁排空是应通过注射胆囊收缩素八肽（CCK - 8）推注还是持续输注来诱导。
通过动态胆囊闪烁显像测量胆囊排空。12名健康受试者和6名胆结石患者在相同情况下接受两次CCK - 8输注胆囊闪烁显像检查，以0.3 ng CCK - 8/kg每分钟的速度输注60分钟。另外6名健康受试者在两次单独的胆囊闪烁显像检查期间分别随机接受CCK - 8推注（0.04微克/千克）和输注（0.3 ng/kg每分钟，持续60分钟）。推注剂量的选择基于CCK - 8制造商的建议。输注剂量的选择是为了使血浆CCK浓度与餐后血浆CCK水平相似。
胆囊排空参数平均射血分数（EF）定义为100%减去归一化至100%的时间 - 活性曲线下面积，再除以从每分钟最大计数到最小计数的时间间隔。在健康受试者的可重复性方面，该参数被证明优于著名的参数EFmax和EF30。平均EF回归线的斜率为0.998，截距值约为0%（p = 0.0001）。平均变异系数为4%。除变异系数较高外，在6名患者中观察到类似的可重复性结果。与平均EF和EFmax相比，健康受试者中EF30的测量值在平均值周围的离散度更大，这表明区分正常与异常胆囊排空的能力较差。静脉推注CCK - 8导致胆囊排空不完全，平均EF值为16%（标准差9%；范围7% - 32%），而CCK - 8输注后为49%（标准差7%；范围37% - 57%）（p = 0.004）。推注后所有受试者均出现腹部不适，而输注期间未报告任何不适。
平均EF是描述胆囊排空的最佳参数。此外，缓慢输注生理剂量的CCK - 8更适合诱导胆囊排空，因为它能导致更完全的排空且无副作用。
