2023 年第 10 期 第 18 卷

18F-脱氧葡萄糖正电子发射计算机断层显像/X线计算机体层成像在发热待查患者中的诊断价值及相关因素分析

Diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computer tomography in patients with fever of unknown origin and analysis of associated factors

作者：杨晓娟颜学兵

英文作者：Yang Xiaojuan Yan Xuebing

单位：徐州医科大学附属医院感染科，徐州221004

英文单位：Department of Infectious Disease the Affiliated Hospital of Xuzhou Medical University Xuzhou 221004 China

关键词：发热待查；18F-脱氧葡萄糖正电子发射计算机断层显像/X线计算机体层成像；准确率；白细胞计数；血红蛋白水平

英文关键词：Feverofunknownorigin;18F-fluorodeoxyglucosepositronemissiontomography/computertomography;Accuracy;Whitebloodcellcount;Hemoglobinlevel

• 摘要：

• 目的  探索¹⁸F-脱氧葡萄糖（FDG）正电子发射计算机断层显像/X线计算机体层成像(PET/CT)在发热待查患者中的诊断价值，筛选有助于提高¹⁸F-FDG PET/CT诊断效能的临床参数。方法  回顾性收集2018年7月至2022年7月在徐州医科大学附属医院诊治的163例发热待查患者的临床资料，最终诊断由组织学结果或有效的临床治疗确定。将发热待查病因分为主要的感染性疾病组（48例）、非感染性炎症性疾病(NIID)组（42例）、肿瘤性疾病组（33例），分析发热待查不同病因间的临床差异。分析¹⁸F-FDG PET/CT对发热待查患者的诊断价值。结果  ¹⁸F-FDG PET/CT的准确率、敏感度、特异度、阳性预测值、阴性预测值分别为49.7%、78.8%、17.9%、51.1%、43.8%。感染性疾病组、NIID组、肿瘤性疾病组3组间白细胞计数、血清铁蛋白、乳酸脱氢酶、红细胞沉降率、最大标准化摄取值差异均有统计学意义（均P<0.05）。白细胞计数（比值比=0.890，95%置信区间：0.809～0.978，P=0.016）、血红蛋白水平（比值比=0.981，95%置信区间：0.963～0.999，P=0.034）与¹⁸F-FDG PET/CT的真阳性率呈负相关，C反应蛋白则无明显相关性（比值比=1.005，95%置信区间：1.000～1.010，P=0.073）。结论  对于发热待查患者，¹⁸F-FDG PET/CT是有效的诊断工具，对于低白细胞计数及低血红蛋白水平患者应尽早行¹⁸F-FDG PET/CT检查，有助于疾病早期诊断与治疗。

• Objective  To explore the diagnostic value of ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computer tomography(PET/CT) in patients with fever of unknown origin(FUO), and to screen the clinical parameters that would improve the diagnostic efficiency of ¹⁸F-FDG PET/CT. Methods  Clinical data of 163 FUO patients from July 2018 to July 2022 were collected retrospectively in the Affiliated Hospital of Xuzhou Medical University. The final diagnosis was determined by histological results   or effective clinical treatment. The etiology of FUO was divided into the main infectious diseases group(48 cases), non infectious inflammatory diseases(NIID) group(42 cases) and tumor disease group(33 cases), and the clinical differences between different causes of FUO were analyzed. The diagnostic value of ¹⁸F-FDG PET/CT in FUO patients was analyzed. Results  The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of ¹⁸F-FDG PET/CT were 49.7%, 78.8%, 17.9%, 51.1% and 43.8% respectively. There were significant differences in white blood cell count, serum ferritin, lactate dehydrogenase, erythrocyte sedimentation rate and maximum standardized uptake value among the infectious diseases group, NIID group and tumor disease group(all P<0.05). White blood cell count(odds ratio=0.890, 95% confidence interval: 0.809-0.978, P=0.016) and hemoglobin level(odds ratio=0.981, 95% confidence interval: 0.963-0.999, P=0.034) were negatively correlated with the true positive rate of ¹⁸F-FDG PET/CT, while C-reactive protein was not significantly correlated(odds ratio=1.005, 95% confidence interval: 1.000-1.010, P=0.073). Conclusions¹⁸F-FDG PET/CT is an effective tool in the diagnosis of FUO patients. For patients with low white blood cell count and low hemoglobin level, ¹⁸F-FDG PET/CT should be performed as early as possible, which is helpful for early diagnosis and treatment of the disease.