应用统计参数图软件分析阿尔茨海默病脑白质葡萄糖代谢变化  

Change of cerebral metabolism rate of glucose of cerebral white matter in Aizheimer's disease:a study with statistical parametric mapping software

作　　者：曹秋云[1] 郭万华[2] 杨海龙[1] 沈迪文[1] 赵鹏[1] 江开达[3] 张明园[3] 肖世富[3] 

机构地区：[1]南京大学医学院附属鼓楼医院医学心理科,210008 [2]南京大学医学院附属鼓楼医院医学核医学科 [3]上海市精神卫生中心

出　　处：《中华医学杂志》2007年第39期2777-2779,共3页National Medical Journal of China

基　　金：上海市医学领先专业老年精神病科重点学科课题基金(95-Ⅲ-011)

摘　　要：目的探讨阿尔茨海默病(AD)脑白质葡萄糖代谢异常的分布及意义。方法收集13例符合 DSM-IV 诊断标准的 AD 患者,其中6例有痴呆精神行为症状(BPSD),7例无 BPSD,健康对照10名。对所有入组者进行脑正电子发射断层成像(PET)检查;应用统计参数图(SPM2000)对 PET 图像进行以像素为基础的统计学处理。结果 (1)AD 患者存在广泛的白质葡萄糖代谢低于健康对照者,较为明显的区域有右侧额叶皮质下白质、左侧额叶上中回皮质下白质(P=0.001);(2)AD 患者左侧额叶内侧回皮质下白质、左侧枕叶楔回皮质下白质葡萄糖代谢高于健康对照者(P=0.001);(3)伴有 BPSD 的 AD 患者在左右枕叶中回、左侧枕叶楔回、右侧顶下小叶、左侧颞叶梭形回、左侧额叶内侧回等脑区的皮质下白质葡萄糖代谢高于不伴有 BPSD 的 AD 患者(P=0.001);而左右额叶中央旁回、右侧额叶上回和中回、左侧颞叶上回等脑区的皮质下白质葡萄糖代谢低于不伴有 BPSD 的 AD 患者(P=0.001)。结论 AD 脑葡萄糖代谢有广泛的白质代谢异常,主要表现为额、顶、颞叶皮质下联络区白质代谢较低,额叶内侧回及枕叶楔回皮质下白质代谢较强,而且 BPSD 症状与相关部分脑区代谢异常相关。Objective To study the change of cerebral metabolism rate of glucose （CMRglc） of cerebral white matter in Alzheimer＇ s Disease. Methods Positron emission tomography （PET） was performed on 13 AD patients, 6 with behavioral and psychological symptoms of dementia （BPSD） and 7 without BPSD, and 10 healthy controls. The regional cerebral metabolism of glucose （rCMRglc） of some brain regions and nuclei were detected. Results （ 1 ） The rCMRglc of the cerebral white matter decreased extensively in the AD patients, especially in the right frontal lobe, superior gyrus of the left frontal lobe（ P = 0. 001 ）. （2） The rCMRglc of subcortical white matter of the left medial prefrontal lobe and the left cuneus of occipital lobe increased in the AD patients. （3） The levels of rCMRglc of the subcortical white matter of both side middle occipital lobe, left cuneus of occipital lobe, right inferior parietal lobule, left fusiform gyrus of temporal lobe and the left medial prefrontal lobe were all significantly higher in the AD patients with BPSD than in those without BPSD （ P = 0. 001 ）. While the levels of rCMRglc of the subcortical white matter of both side paracentral lobule, right superior and middle frontal lobe, and left superior temporal lobe were all significantly lower in the AD patients with BPSD than in those without BPSD （all P=0.001）. Conclusion There is diffuse abnormal rCMRglc in the cerebral white matter in the AD patients： the rCMRglc decreases in the frontal-temporal-occipital association area, and the rCMRglc of the medial prefrontal lobe and cuneus of occipital lobe increases. BPSD is correlated with the abnormal metabolism of related cerebral regions.

关 键 词：阿尔茨海默病 体层摄影术 X线计算机 葡萄糖 代谢 

分 类 号：R749.16[医药卫生—神经病学与精神病学]