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四、 分子影像学在结核病诊断中的应用
虽然CT和FDG PET/CT在发现、监测结核感染及评估结核治疗的临床运用越来越多,但是它们最大的局限性在于缺乏特异性。很多不同类型的代谢活跃的细胞均能摄取 18F-FDG,由于活化的巨噬细胞是结核相关炎症的主要成分,巨噬细胞示踪剂能作为检测结核分枝杆菌更有特异性的显像剂。转运蛋白分子(TSPO)的表达增强是小神经胶质细胞和巨噬细胞活化的特性。一些学者用TSPO作为分子靶标进行神经炎症成像,并采用各种TSPO特异性放射性配体检测周围组织炎症。Foss等 [45]对TSPO低分子量吡唑并嘧啶配体——放射性碘化-DPA-713作为老鼠结核模型的肺结核相关炎症影像生物标志物进行了评估。发现SPECT影像能清楚显示活体动物内结核相关肺感染。生物分布研究证实放射示踪物对炎性改变的肺组织有特异性。免疫荧光研究显示TSPO在结核病灶CD68 +巨噬细胞和吞噬细胞中高度表达, 125I-DPA-713高度聚集在这些细胞中。同一只老鼠中病变特异性信噪比 125I-DPA-713 SPECT明显比 18F-FDG PET高[(4.06+0.52)vs(2.00+0.28), P=0.04]。由此证明 125I-DPA-713是监测体内结核病灶更特异性的生物标记。
(谢汝明 侯代伦 李芳 张旭 刘一典 唐神结)
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