作者投稿
专家审稿
编辑办公
邮件订阅
RSS
Development and Prospect of Theranostic Medical Isotopes and Radiopharmaceuticals in China
-
摘要: 核医学诊疗一体化是将放射性核素显像与内放射治疗相结合，从而实现疾病的可视化诊断和精准治疗。目前，核医学诊疗一体化已在分化型甲状腺癌、嗜铬细胞瘤、恶性肿瘤骨转移、神经内分泌肿瘤、前列腺癌中发挥重要作用。我国医用放射性核素及放射性药物短缺，严重依赖进口，存在“卡脖子”问题，应加强诊疗一体化医用放射性核素及放射性药物的自主生产与创新研发力度，以促进核医学诊疗一体化更好地服务我国临床实践。Abstract: Theranostics in nuclear medicine is the combination of radionuclide imaging and internal radiotherapy, so as to realize the visualized diagnosis and precise treatment of diseases. At present, theranostics of nuclear medicine has played an important role in differentiated thyroid carcinoma, pheochromocytoma, bone metastases, neuroendocrine tumors and prostate cancer. China's medical radionuclides and radionuclide medicines are in short supply and heavily dependent on imports, so there is a "bottleneck" problem. It is necessary to strengthen the independent production, innovation and research of medical radionuclides and radiopharmaceutics of theranostics, so as to promote theranostics of nuclear medicine to better serve China's clinical practice.
-
Keywords:
- theranostics /
- nuclear medicine /
- radionuclide /
- thyroid carcinoma /
- neuroendocrine neoplasms
-
经过一天烈日的炙烤，住院部外面的地表温度已经高达40 ℃，进进出出需要加强监护的患者还在不断增加，面对监护室内堆积如山的病患，大家的心情已经烦躁不安。高速周转的病房似乎又经历了一波“大洗牌”，病床上躺着不同的面孔，交班正仔细且有序地进行着。“号外……又有新病人要从急诊科转入，目前鼻导管10 L/min吸氧中，呼吸困难，需要重新评估插管指征......”值班护士小罗一边接听着电话，一边冲大家喊道。此刻空气仿佛凝住了一般，最尴尬的事情莫过如此——在交班时要来病人。“大家先交班，速战速决，准备收病人......”作为今天当值的高年资主治医师，我立刻说道。
伴随着转运车的声音，病人送来了，大家立刻围了上去，按照平时标准动作过床、吸氧、完成心电监护连接。我走到病床边，那是一位白发苍苍、胸前皮下还隐约有一枚“勋章”的爷爷，一看心电监护，我本能地反应那枚东西应该是心脏永久起搏器。为了判断病人意识及症状，我拍了拍老人肩膀，问道：“爷爷，您知道这是在哪儿吗？”老人没有回答，但是眼睛在不停地转动，嘴巴似乎要表达什么，带着一点儿北方口音，但听得不太清楚。我瞬时像明白了什么，于是俯下身去对着他的耳朵大声喊道：“爷爷，您知道这是在哪儿吗？您是不是听得不太清楚？”老人摇了摇头，又点了点头。
此时，我身旁一位经验丰富的“老医生”冲我扬了扬手中的听诊器听筒，我第一反应是她要听诊，于是连忙说道：“我来吧。”但她却直接把听头给爷爷戴上了，并对着听筒大声说道：“老爷子，这样能听清吗？”老人喃喃地回答：“听清了，听清了……”慢慢地，他紧崩的神情似乎也逐渐舒展开来。经过一系列问诊和针对性的处理后，爷爷慢慢睡着了。
病人急性呼吸窘迫的病因尚未完全明确，依然有病情随时加重的危险，依照惯例，我们立即联系家属了解老人的病史并进行谈话签字。通过与家属充分沟通，我们了解到了爷爷的慢性病史以及本次发病的诱因，还得知爷爷听力不好，这几天辗转各大医院，一直没休息好，病情也越来越重了。好在经过我们悉心的治疗和照顾，两周后爷爷终于出院了！
门诊复诊时，我看到爷爷耳朵上多了一副助听器，便打趣道：“爷爷，现在声音清楚多了吧？”爷爷笑着回答：“这玩意儿还是没有你们给我戴的东西听得清楚。”我和家属听完都哈哈大笑起来……
后记
听诊器的发明已有近200年的历史，其除了可以帮助医生完成重要的听诊检查外，在某些情况下还可以成为与病人沟通的桥梁。从法国医生雷奈克为了诊治患者，第一次提出“听诊器”的概念，到吴孟超院士在冬天查房时先用双手捂热听诊器再为患者听诊，再到为了能让患者听清楚，发现听诊器的新用途……不同听诊器的故事中，有不同的主人公以及不同的场景，但伴随的都是那份来自医生的爱，那份给予患者温暖的爱。病人与医生之间的第一步，是沟通，是了解，但病人在任何时候和任何状态下，都一定是需要帮助的那个人。任何人在面对身体的病痛时，或是因为没有足够专业的知识，或是因为疾病带来的切肤之痛，无论是酸胀、麻木、疼痛、无力，还是其他任何一种异样的感觉，都会让其内心产生对于异常表现的无限猜测以及随之而来的焦虑、恐慌。初入医学院时的我，心里想的只是如何掌握高精尖的各种医学技术，如何把病看好。进入医院工作多年以后，特别是在经历新型冠状病毒感染疫情后，我深切地体会到，不管医生的技术有多精湛，医疗水平有多高超，医生的关怀和援助永远都是病人最坚实的情感堡垒。治病一定是依靠科学，但让病人感觉到舒服却更需要医生对于患者那颗帮助的心。从医和患这层关系构建起来的那一刻起，他们就不该是对立的，而是共生的，更是共情的，感同身受、同气连枝才是医治疾病的起点，更是每一个合格医生毕生追求的终点。
临床医生正如其名字一样，需要站在床边仔细观察病人。观察的目的除正确诊断病情外，更重要的是察觉病人最需要的帮助是什么。故事中的老人一直处于听不清周围声音的状态，这时候病人可能会感到恐惧与烦躁，甚至会导致病情恶化，而一次仔细的观察就能够使问题迎刃而解。一个小小的听诊器，以及听诊器带来的这份“逆向思维”，彰显的不仅是一种临床采集病史的技巧，更是医生把心打开，试图去侧耳倾听病人诉说的耐心，以及尽其所能去关爱病人的慈悲。
因此，听诊器的故事，讲述的不是一种疾病的诊断，更不是一个病例的转归，听诊器联通的亦非症状与诊断，心跳与鼓膜，而是受伤的心和呵护的手，告诉我你哪里不舒服，我一定会想办法听到你的诉说，也一定会陪着你直到疾病消散。把痛苦告诉我，把希望传给你，这才是听诊器的真正意义所在，才是医生和病人最正确的相处方式。一如美国医生特鲁多对医生这个职业的经典描述——有时是治愈，常常是帮助，总是去安慰！
利益冲突：作者声明不存在利益冲突 -
诊断性放射性药物 治疗性放射性药物 临床诊断与治疗病种 Na123I、Na124I Na131I 分化型甲状腺癌 123I-MIBG、124I-MIBG 131I-MIBG 嗜铬细胞瘤 99mTc-MDP、18F-NaF 89SrCl2、223RaCl2 恶性肿瘤骨转移 68Ga-DOTATATE 177Lu-DOTATATE 神经内分泌肿瘤 68Ga-PSMA 177Lu-PSMA 前列腺癌 
下载: 导出CSV
表 2 具有应用前景的诊疗一体化核素
诊断性放射性核素 配对的治疗性放射性核素 123I/124I 131I 68Ga 177Lu 68Ga 225Ac 64Gu 67Gu 44Sc 47Sc 152Tb 161Tb 86Y 90Y 99mTc 188Re
下载: 导出CSV
-
[1] Filippi L, Chiaravalloti A, Schillaci O, et al. Theranostic approaches in nuclear medicine: current status and future prospects[J]. Expert Rev Med Devices, 2020, 17: 331-343. DOI: 10.1080/17434440.2020.1741348
[2] Jokar N, Assadi M, Yordanova A, et al. Bench-to-Bedside Theranostics in Nuclear Medicine[J]. Curr Pharm Des, 2020, 26: 3804-3811. DOI: 10.2174/1381612826666200218104313
[3] Solnes LB, Shokeen M, Pandit-Taskar N. Novel Agents and Future Perspectives on Theranostics[J]. Semin Radiat Oncol, 2021, 31: 83-92. DOI: 10.1016/j.semradonc.2020.07.010
[4] O'Dwyer E, Bodei L, Morris MJ. The Role of Theranostics in Prostate Cancer[J]. Semin Radiat Oncol, 2021, 31: 71-82. DOI: 10.1016/j.semradonc.2020.07.004
[5] 张锦明, 杜进. 中国放射性药物制备的现状及展望[J]. 同位素, 2019, 32: 178-185. DOI: 10.7538/tws.2019.32.03.0178 Zhang JM, Du J. Preparation of Radiopharmaceuticals in China: Current Status and Prospects[J]. Tongweisu, 2019, 32: 178-185. DOI: 10.7538/tws.2019.32.03.0178
[6] Bozkurt MF, Virgolini I, Balogova S, et al. Guideline for PET/CT imaging of neuroendocrine neoplasms with 68Ga-DOTA-conjugated somatostatin receptor targeting peptides and 18F-DOPA[J]. Eur J Nucl Med Mol Imaging, 2017, 44: 1588-1601. DOI: 10.1007/s00259-017-3728-y
[7] Strosberg J, El-Haddad G, Wolin E, et al. NETTER-1 Trial Investigators. Phase 3 Trial of 177Lu-Dotatate for Midgut Neuroendocrine Tumors[J]. N Engl J Med, 2017, 376: 125-135. DOI: 10.1056/NEJMoa1607427
[8] Ali N, Sebastian C, Foley RR, et al. The management of differentiated thyroid cancer using 123I for imaging to assess the need for 131I therapy[J]. Nucl Med Commun, 2006, 27: 165-169. DOI: 10.1097/01.mnm.0000194397.20067.b6
[9] Nagarajah J, Janssen M, Hetkamp P, et al. Iodine Symporter Targeting with 124I/131I Theranostics[J]. J Nucl Med, 2017, 58: 34S-38S. DOI: 10.2967/jnumed.116.186866
[10] Gulec SA, Kuker RA, Goryawala M, et al. 124I PET/CT in Patients with Differentiated Thyroid Cancer: Clinical and Quantitative Image Analysis[J]. Thyroid, 2016, 26: 441-448. DOI: 10.1089/thy.2015.0482
[11] Furuta N, Kiyota H, Yoshigoe F, et al. Diagnosis of pheochromocytoma using[123I]-compared with[131I]-metaiodobenzylguanidine scintigraphy[J]. Int J Urol, 1999, 6: 119-124. DOI: 10.1046/j.1442-2042.1999.06310.x
[12] Pryma DA, Chin BB, Noto RB, et al. Efficacy and Safety of High-Specific-Activity 131I-MIBG Therapy in Patients with Advanced Pheochromocytoma or Paraganglioma[J]. J Nucl Med, 2019, 60: 623-630. DOI: 10.2967/jnumed.118.217463
[13] Willegaignon J, Crema KP, Oliveira NC, et al. Pediatric 131I-MIBG Therapy for Neuroblastoma: Whole-Body 131I-MIBG Clearance, Radiation Doses to Patients, Family Caregivers, Medical Staff, and Radiation Safety Measures[J]. Clin Nucl Med, 2018, 43: 572-578. DOI: 10.1097/RLU.0000000000002158
[14] Weber M, Schmitz J, Maric I, et al. Diagnostic performance of 124I-m-iodobenzylguanidine PET/CT in patients with pheochromocytoma[J]. J Nucl Med, 2021. doi: 10.2967/jnumed.121.262797.
[15] 支修益, 石远凯, 于金明. 中国原发性肺癌诊疗规范(2015年版)[J]. 中华肿瘤杂志, 2015, 37: 67-78. DOI: 10.3760/cma.j.issn.0253-3766.2015.01.014 Zhi XY, Shi YK, Yu JM. Standards for the diagnosis and treatment of primary lung cancer(2015 version) in China[J]. Zhonghua Zhongliu Zazhi, 2015, 37: 67-78. DOI: 10.3760/cma.j.issn.0253-3766.2015.01.014
[16] 陈跃, 赵军, 吴湖炳, 等. 18F-NaF PET/CT骨显像操作指南[J]. 中华核医学与分子影像杂志, 2016, 36: 76-78. DOI: 10.3760/cma.j.issn.2095-2848.2016.01.018 Chen Y, Zhao J, Wu HB, et al. Operation guide of 18F-NaF PET/CT bone imaging[J]. Zhonghua Heyixue Yu Fenzi Yingxiang Zazhi, 2016, 36: 76-78. DOI: 10.3760/cma.j.issn.2095-2848.2016.01.018
[17] Handkiewicz-Junak D, Poeppel TD, Bodei L, et al. EANM guidelines for radionuclide therapy of bone metastases with beta-emitting radionuclides[J]. Eur J Nucl Med Mol Imaging, 2018, 45: 846-859. DOI: 10.1007/s00259-018-3947-x
[18] Manafi-Farid R, Masoumi F, Divband G, et al. Targeted Palliative Radionuclide Therapy for Metastatic Bone Pain[J]. J Clin Med, 2020, 9: 2622. DOI: 10.3390/jcm9082622
[19] Sadremomtaz A, Masoumi M. Comparison between Targeted Radionuclide Therapy of Bone Metastases Based on β-Emitting and α-Emitting Radionuclides[J]. J Med Imaging Radiat Sci, 2019, 50: 272-279. DOI: 10.1016/j.jmir.2018.12.005
[20] Sanli Y, Garg I, Kandathil A, et al. Neuroendocrine Tumor Diagnosis and Management: 68Ga-DOTATATE PET/CT[J]. AJR Am J Roentgenol, 2018, 211: 267-277. DOI: 10.2214/AJR.18.19881
[21] 陈跃, 霍力, 兰晓莉, 等. 68Ga-DOTA-生长抑素受体PET/CT神经内分泌肿瘤显像操作指南[J]. 中国医学影像技术, 2019, 35: 1441-1444. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX201909001.htm Chen Y, Huo L, Lan XL, et al. Guideline of 68Ga-DOTA-conjugated somatostatin receptor PET/CT imaging in neuroendocrine neoplasms[J]. Zhongguo Yixue Yingxiang Jishu, 2019, 35: 1441-1444. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX201909001.htm
[22] Zhang J, Song Q, Cai L, et al. The efficacy of 177Lu-DOTATATE peptide receptor radionuclide therapy (PRRT) in patients with metastatic neuroendocrine tumours: a systematic review and meta-analysis[J]. J Cancer Res Clin Oncol, 2020, 146: 1533-1543. DOI: 10.1007/s00432-020-03181-2
[23] Farolfi A, Lima GM, Oyen W, et al. Molecular Imaging and Theranostics-A Multidisciplinary Approach[J]. Semin Nucl Med, 2019, 49: 247-254. DOI: 10.1053/j.semnuclmed.2019.02.002
[24] Hamed M, Basha M, Ahmed H, et al. 68Ga-PSMA PET/CT in Patients with Rising Prostatic-Specific Antigen After Definitive Treatment of Prostate Cancer: Detection Efficacy and Diagnostic accuracy[J]. Acad Radiol, 2019, 26: 450-460. DOI: 10.1016/j.acra.2018.05.020
[25] 陈跃, 霍力, 兰晓莉, 等. 68Ga-前列腺特异性膜抗原PET/CT前列腺癌显像操作指南[J]. 中国医学影像技术, 2019, 35: 1281-1284. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX201910001.htm Chen Y, Huo L, Lan XL, et al. Guideline of 68Ga-PSMA PET/CT imaging in prostatic cancer[J]. Zhongguo Yixue Yingxiang Jishu, 2019, 35: 1281-1284. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX201910001.htm
[26] Yadav MP, Ballal S, Sahoo RK, et al. Radioligand Therapy With 177Lu-PSMA for Metastatic Castration-Resistant Prostate Cancer: A Systematic Review and Meta-Analysis[J]. AJR Am J Roentgenol, 2019, 213: 275-285. DOI: 10.2214/AJR.18.20845
[27] Kratochwil C, Fendler WP, Eiber M, et al. EANM procedure guidelines for radionuclide therapy with 177Lu-labelled PSMA-ligands (177Lu-PSMA-RLT)[J]. Eur J Nucl Med Mol Imaging, 2019, 46: 2536-2544. DOI: 10.1007/s00259-019-04485-3
[28] Yadav MP, Ballal S, Sahoo RK, et al. Efficacy and safety of 225Ac-PSMA-617 targeted alpha therapy in metastatic castration-resistant Prostate Cancer patients[J]. Theranostics, 2020, 10: 9364-9377. DOI: 10.7150/thno.48107
[29] Goldsmith SJ. Targeted Radionuclide Therapy: A Historical and Personal Review[J]. Semin Nucl Med, 2020, 50: 87-97. DOI: 10.1053/j.semnuclmed.2019.07.006
[30] Jokar N, Velikyan I, Ahmadzadehfar H, et al. Theranostic Approach in Breast Cancer: A Treasured Tailor for Future Oncology[J]. Clin Nucl Med, 2021, 46: e410-e420. DOI: 10.1097/RLU.0000000000003678
[31] Jadvar H. Targeted α-Therapy in Cancer Management: Synopsis of Preclinical and Clinical Studies[J]. Cancer Biother Radiopharm, 2020, 35: 475-484. DOI: 10.1089/cbr.2019.3340
[32] Brito AE, Etchebehere E. Radium-223 as an Approved Modality for Treatment of Bone Metastases[J]. Semin Nucl Med, 2020, 50: 177-192. DOI: 10.1053/j.semnuclmed.2019.11.005
[33] Frantellizzi V, Cosma L, Brunotti G, et al. Targeted Alpha Therapy with Thorium-227[J]. Cancer Biother Radiopharm, 2020, 35: 437-445. DOI: 10.1089/cbr.2019.3105
[34] Anand A, Trägårdh E, Edenbrandt L, et al. Assessing Radiographic Response to 223Ra with an Automated Bone Scan Index in Metastatic Castration-Resistant Prostate Cancer Patients[J]. J Nucl Med, 2020, 61: 671-675. DOI: 10.2967/jnumed.119.231100
计量
- 文章访问数: 2596
- HTML全文浏览量: 1937
- PDF下载量: 765
