目的分析 99Tc m-二巯基丁二酸(DMSA)用于儿童肾静态显像的剂量-效应(量-效)关系。
方法回顾性收集2022年1月至2023年11月间于华中科技大学同济医学院附属武汉儿童医院接受 99Tc m-DMSA肾静态显像患儿的资料(模型组199例，男81例、女118例；验证组30例，男13例、女17例；年龄均为1个月～14岁)，记录每例患儿给药后双肾扫描放射计数及相关临床信息，采用视觉模拟评分(VAS)法对显像质量进行评价，采用ROC曲线分析探讨放射计数强度(RCI)与显像质量间的关系。采用非线性混合效应建模法建立 99Tc m-DMSA用于儿童肾静态显像的量-效关系模型，进行内外部验证，并基于最终模型，评价患儿的给药方案。
结果患儿体质量是影响 99Tc m-DMSA肾静态显像量-效关系的因素( χ 2值：120.79和116.36，均 P<0.05)。ROC曲线分析显示，当患儿肾前位RCI≥32.61(界值)、肾后位RCI≥35.46(界值)时图像质量满足诊断要求。内部和外部验证结果显示，建立的量-效模型预测性能较好。基于最终模型剂量折线图剂量给药，图像质量可以满足临床诊断要求。
结论成功建立 99Tc m-DMSA用于患儿肾静态显像的量-效关系模型，基于模型的患儿个体化给药剂量可为临床个体化给药剂量决策提供科学依据。
ObjectiveTo analyze the dose-response relationship of 99Tc m-dimercaptosuccinic acid (DMSA) in pediatric renal static imaging.
MethodsA retrospective analysis of children (model group: n=199, 81 males, 118 females; validation group: n=30, 13 males, 17 females; all age: 1 month-14 years) who underwent 99Tc m-DMSA renal static imaging from January 2022 to November 2023 in Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology were conducted. Post-administration radiation counts and related clinical data were collected. Imaging quality was evaluated using visual analogue scoring (VAS). ROC curve analysis was used to assess the relationship between radiation count intensity (RCI) and imaging quality. A nonlinear mixed-effects modeling method was employed to establish the dose-response relationship for 99Tc m-DMSA in pediatric renal static imaging. Internal and external validations of the model were performed. Final model was utilized to evaluate patient dosing protocols.
ResultsBody weight was considered as a significant determinant of the dose-response relationship in 99Tc m-DMSA renal static imaging( χ 2 values: 120.79, 116.36, both P<0.05). ROC curve analysis showed that the quality of diagnostic images was acceptable when the anterior renal RCI was ≥32.61 (cut-point) and the posterior renal RCI was ≥35.46 (cut-point). Both internal and external validation results demonstrated that the dose-response model established exhibited good prediction performance. Based on the final model graph, the image quality could meet the requirements for clinical diagnosis.
ConclusionsThe 99Tc m-DMSA dose-response model for pediatric renal static imaging is successfully established. Individualized dosage based on the model can provide a reference for clinical individualized dosing decision-making.
谢力斯,吴敏,王朝阳,等. 应用非线性混合效应建模法评估 99Tc m-DMSA用于儿童肾静态显像的量-效关系 [J]. 中华核医学与分子影像杂志,2024,44(12)：724-729.
DOI:10.3760/cma.j.cn321828-20240124-00033版权归中华医学会所有。
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谢力斯：研究实施、论文撰写；吴敏、王朝阳、方磊、刘涛、李梅、李环：研究实施；王芳：研究指导、论文修改；汪洋：研究指导、统计学分析、论文修改
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