Abstract:

Abstract： Objective To investigate the characteristics of 99mTcmsulfur collid bone marrow scintigraphy in childhood aplastic anemia （AA） and its clinical significance.Methods A total of 45 children were newly diagnosed with AA，including 19 cases of serious aplastic anemia （SAA） and 26 cases of chronic aplastic anemia （CAA）.Bone marrow scintigraphy using 99mTcmsulfur collid 10～15 MBq/kg was performed in 45 patients and 15 controls.The difference of bone marrow scintigraphy was analysed. The relationship between laboratory indices and clinical response was investigated. Results According to the bone marrow imaging results，grade 2 of marrow activities was defined as normal. Totally 33 patients（33/45，73.3%） had abnormal marrow activities，and in 15 controls only 3（3/15，20%）.Most AA patients showed 99mTcmsulfur collid uptake decrease. CAA patients had higher marrow activities than SAA patients （P＜0.05）.In the 33 patients who had abnromal marrow activities（less then 2 grade），SAA and CAA patients showed different 99mTcmsulfur collid uptake in the peripheral and the center of bone marrow，and CAA had focals whose uptake was increasing.After treatment of 6 months，45 AA patients were investigated the relationship between the grade of marrow activities and the therapeutic effect（including improved，inefficacy，death）.There showed significantly difference（P＜0.05） between them. Conclusion The 99mTcmsulfur collid bone marrow imaging is helpful to the diagnosis and prognosis of AA，but further study is needed to judge its relationship with the curative effect and prognosis.

Key words: aplastic anemia, childhood, bone marrow, scintigraphy

摘要：

目的 应用99mTc-硫胶体全身骨髓显像检测再生障碍性贫血（再障）患儿全身骨髓显影特点，探讨其在再障诊治中的价值。方法　对2009年1月至2012年1月青岛大学医学院附属医院小儿血液科收治的45例再障患儿（再障组）及15名对照组进行99mTc-硫胶体全身骨髓显像。99mTc-硫胶体注射放射剂量10～15 MBq/kg，分析骨髓核素显像的特异性、敏感性及不同类型再障患儿骨髓显像特点和临床转归的相关性。结果　再障组45例骨髓显像中活性减低33例（73.3%，包括0级11例、1级22例），表现为全身骨髓显像有不同程度受抑，其特点是全身骨髓显影不良、显影骨髓总量减少；2级12例（26.7%），骨髓活性正常。45例再障组临床诊断为急性再障（SAA）组19例、慢性再障（CAA）组26例，其中SAA组骨髓显像表现为中央＋外周骨髓均抑制者15例，仅中央骨髓抑制2例；CAA组中央＋外周骨髓均抑制6例，仅中央周骨髓抑制6例，仅外周抑制4例；两组骨髓显像抑制部位差异有统计学意义（χ2= 10.37，P＜0.05）；提示慢性再障骨髓显像受抑程度较轻，可仅有中央或外周骨髓的抑制并多存在灶状增生。对再障患儿骨髓显像与早期治疗反应进行统计分析，结果示不同骨髓显像分级间疗效差异有统计学意义（χ2=12.49，P＜0.05），骨髓显像0级组有效率为36.3%，较1级组、2级组（77.3%、83.4%）疗效差。结论　全身骨髓显影不良、显影骨髓总量减少及显像特点有助于对儿童再障的诊断、分型及预后判断。骨髓显像与临床转归和预后关系仍需进一步扩大病例研究。

关键词: 再生障碍性贫血, 儿童, 骨髓, 放射性核素显像