不同严重程度的阿尔茨海默病的正电子发射断层显像研究  

Measurement of regional cerebral metabolism rate of glucose in patients with Alzheimer′s disease in different levels of severity

作　　者：肖世富[1] 曹秋云[1] 薛海波[1] 刘永昌[2] 左传涛[2] 江开达[1] 张明园[1] 

机构地区：[1]上海市精神卫生中心,200030 [2]复旦大学医学院华山医院PET中心

出　　处：《中华医学杂志》2005年第42期2975-2979,共5页National Medical Journal of China

基　　金：上海市医学发展基金重点研究资助项目(993030);上海市卫生系统百人计划资助项目(98BR033)

摘　　要：目的探讨阿尔茨海默病(AD)的脑葡萄糖代谢变化的诊断价值.方法对10例AD患者(AD组)和10例年龄、性别和文化程度匹配的正常对照者(NC组)进行18氟脱氧葡萄糖正电子发射断层显像检查(PET)并分析两组间不同脑区脑葡萄糖代谢的差异.结果 AD组与NC组比较,有多个感兴趣脑区的局部葡萄糖代谢率显著降低(P<0.05,P<0.01),在额叶的上、中、下回和眶回代谢下降17.0%～28.4%,颞叶的上、中、下回下降3.3%～25.0%,岛叶下降9.3%～9.8%,海马下降10.5%～10.6%,海马旁回下降7.8%～11.3%,前后扣带回下降16.7%～22.7%,右侧尾状核下降10.6%,顶颞枕叶联结区下降12.7%～14.5%.其中,额上回、额中回、眶回、颞中回和前扣带回代谢降低最明显,均超过20%.轻度痴呆代谢降低的脑区较少,程度也较轻.右颞下回、左海马、左颞上回和右岛叶判别的正确率达100%(均P<0.01).结论 PET能灵敏地反映AD的脑葡萄糖代谢变化,具有很高的诊断价值.AD的脑葡萄糖代谢缺陷主要集中在额叶、颞叶和海马结构,呈额-颞叶型缺陷,代谢缺陷程度和范围与痴呆程度密切相关.海马、海马旁回、前扣带回、颞下回等脑区的葡萄糖代谢下降可能具有早期诊断价值.Objective To measure the changes of regional cerebral metabolism rate of glucose （rCMRglc） in patients with Alzheimer＇s disease （AD） and explore their value to diagnosis of AD. Methods 10 patients with AD whomet the diagnostic criteria of DSM-IV and 10 normal controls （NC） were assessed with ^18 F-2-fluoro-deoxy-D-glucose positron emission tomography （PET）. Results The two groups were matched in age, gender and education. The mean total scores of the mini-mental status examination （MMSE） were 16. 5 ±6. 1 for AD and 28.7 ±1.6 for NC. The mean total memory quotient of Wechsler Memory Scales （MQ） were 32. 3 ± 19.6 for AD and 93.1 ±9.0 for NC. Comparing to NC, the AD groups showed statistically significant decline of rCMRglc in frontal lobe, temporal lobe and the hippocampal formation with dereased rates ranged from 3. 3% to 28.4% （P 〈0. 05 ,P 〈0. 01 ）. The hypo-metabolism was more salient in the regions of upper and middle fronta gyri, middle temporal gyral, orbital gyrus and anterior cingulate gyrus, in which areas the metabolism decreased over 20% compared to NC. The hypo-metabolism was correlated to the severity of dementia. Discriminant analysis demonstrated that the variables of right inferior temporal gyrus, left upper temporal gyrus, left hippocampus and right insular lobe were entered into the discriminant functions and the total discriminant accuracy reached 100%. Conclusions ISF-FDG PET is a very sensitive tool in measurement of the changes of rCMRglc in patients with AD. The findings show a frontal-temporal type of metabolism in AD patients and suggest that hypo-metabolism in hippocampal formation and temporal lobe is helpful in early detection of AD.

关 键 词：阿尔茨海默病 体层摄影术 发射型计算机 氟脱氧葡萄糖F18 

分 类 号：R749.1[医药卫生—神经病学与精神病学]