摘要目的:探讨原发性干燥综合征(pSS)患者行腮腺SPECT/CT动态显像获得的基于SUV的定量参数与唇腺病理分级的相关性。方法:前瞻性纳入2022年8月至2024年3月于河北省人民医院确诊的72例pSS患者[男6例、女66例，年龄(51.5±13.8)岁]，获取其唇腺活组织检查(简称活检)的病理分级资料，并进行定量SPECT/CT腮腺动态显像，通过Q-metrix软件得到基于SUV的定量参数：酸刺激前和酸刺激后SUV max、SUV mean、腮腺摄取体积(UVP)、腮腺摄取总量(TPU)以及酸刺激前后参数差值(Δ)。比较唇腺活检病理1～2级和3～4级患者间的各参数差异(两独立样本 t检验或Mann-Whitney U检验)，采用Spearman秩相关分析显像参数与病理分级的相关性，利用ROC曲线(Delong检验)评估定量参数对病理1～2级与3～4级的鉴别能力。 结果:唇腺活检病理分级1～2级患者( n＝30)较3～4级患者( n＝42)的SUV max高[酸刺激前：36.38(27.81，44.17)与15.45(10.77，24.51)， Z＝－5.51， P<0.001；酸刺激后：21.53(16.93，26.21)与11.33(7.32，15.89)， Z＝－5.27， P<0.001]；1～2级患者酸刺激前、后SUV mean、UVP、TPU以及ΔSUV max、ΔSUV mean、ΔTPU也较高( Z值：－4.73～－3.04， t值：6.39、4.50，均 P<0.01)；上述参数与病理分级均呈负相关( rs值：－0.66～－0.36，均 P<0.05)。ΔUVP在病理分级1～2级与3～4级患者间差异无统计学意义( Z＝－1.05， P＝0.293)，且ΔUVP与病理分级不相关( rs＝－0.13， P＝0.297)。ROC曲线分析示，酸刺激前、后SUV max和酸刺激前TPU鉴别病理分级1～2级与3～4级患者的AUC(0.883、0.866和0.888)较高，Delong检验示这3个参数的AUC均高于酸刺激后SUV mean、UVP和ΔUVP的AUC(均<0.800； Z值：2.09～4.65，均 P<0.05)。 结论:基于SUV的腮腺SPECT/CT定量参数可以反映pSS患者的腮腺损伤程度，为pSS的功能诊断和评估提供了新的定量分析方法。

abstractsObjective:To explore the correlation between quantitative parameters based on SUV acquired by dynamic SPECT/CT imaging of parotid glands and pathological grading of labial gland in patients with primary Sj?gren syndrome (pSS).Methods:Seventy-two patients (6 males, 66 females, age (51.5±13.8) years) with confirmed pSS diagnosed at Hebei General Hospital between August 2022 and March 2024 were prospectively included. The clinical data and pathological grading information from labial gland biopsies were analyzed. Dynamic SPECT/CT imaging of the parotid glands was performed, and quantitative parameters based on SUV were obtained using Q-metrix software: SUV max, SUV mean, uptake volume of parotid glands (UVP) and total parotid uptake (TPU) pre/post-acid stimulation, as well as the differences in quantitative parameters before and after acid stimulation (ΔSUV max, ΔSUV mean, ΔUVP, and ΔTPU). The independent-sample t test or Mann-Whitney U test was performed to evaluate the differences in parameters between patients with pathological grade 1-2 and those with pathological grade 3-4. Spearman rank correlation was used to analyze the correlation between quantitative parameters and pathological grading. The performance of quantitative parameters in distinguishing pathological grade 1-2 from grade 3-4 was assessed using ROC curve analysis with Delong test. Results:The SUV max pre/post-acid stimulation in patients with pathological grade 1-2 ( n=30) were higher than those in patients with grade 3-4 ( n=42) (36.38(27.81, 44.17) vs 15.45(10.77, 24.51), Z=-5.51, P<0.001(pre-acid stimulation); 21.53(16.93, 26.21) vs 11.33(7.32, 15.89), Z=-5.27, P<0.001 (post-acid stimulation)). SUV mean, UVP and TPU pre/post-acid stimulation in patients with pathological grade 1-2, as well as ΔSUV max, ΔSUV mean and ΔTPU, were all significantly higher ( Z values: from -4.73 to -3.04, t values: 6.39, 4.50, all P<0.01). Moreover, these parameters were negatively correlated with the pathological grading ( rs values: from -0.66 to -0.36, all P<0.05). No significant difference in ΔUVP was observed between patients with pathological grade 1-2 and those with grade 3-4 ( Z=-1.05, P=0.293), and ΔUVP showed no correlation with pathological grading ( rs=-0.13, P=0.297). Among all parameters, SUV max pre/post-acid stimulation and TPU pre-acid stimulation exhibited better diagnostic performance in differentiating pathological grade 1-2 from grade 3-4, with AUC values of 0.883, 0.866, and 0.888, respectively. Delong test showed that those 3 AUC values were all higher than AUC values of SUV mean, UVP post-acid stimulation and ΔUVP (all AUC<0.800; Z values: 2.09-4.65, all P<0.05). Conclusion:The quantitative parameters of parotid glands based on SUV acquired by dynamic SPECT/CT can reflect the damage degree of parotid glands in patients with pSS, providing novel quantitative analytical tools for the functional diagnosis and assessment of pSS.