帕金森病痴呆患者的脑葡萄糖代谢研究  

Cerebral glucose metabolism in Parkiuson＇s disease with dementia

作　　者：马爱军[1] 张本恕[2] 潘旭东[1] 高硕[3] 李祖贵[3] 

机构地区：[1]青岛大学医学院附属医院东部神经科,266100 [2]天津医科大学总医院神经内科 [3]天津医科大学总医院PET中心

出　　处：《中华医学杂志》2008年第37期2623-2628,共6页National Medical Journal of China

摘　　要：目的探讨帕金森病痴呆（PDD）患者的^18F-脱氧葡萄糖正电子发射体层（^18F-FDG PET）脑显像特点及意义。方法对20例PDD患者、8例非痴呆PD患者和30名相匹配的健康对照进行^18F—FDG PET脑显像，应用视觉分析法和统计参数图（SPM）分析法比较病例组与对照组大脑葡萄糖代谢差异。结果与对照组相比，视觉分析法显示非痴呆PD患者示踪剂分布均匀对称，PDD患者双侧额叶、颞叶、顶叶、枕叶及基底节、丘脑葡萄糖代谢减低；在一定显著性水平（P〈0．001）和像素阈值（K=100像素）下，SPM分析显示非痴呆PD患者仅双侧顶叶后部代谢减低；PDD患者局部脑葡萄糖代谢率（rCMRglc）减低的脑区包括双侧顶上小叶、顶下小叶、额上回、额中回、颞中回、楔叶、扣带回、枕叶舌回、额叶内侧部及壳核、丘脑等部位。根据幻觉及记忆损害程度将PDD分为幻觉（HD）组和记忆障碍（MD）组，2组MMSE及Hoehn—Yahr分级差异无统计学意义（P〉0．05），而HD组的年龄与病程明显低于MD组（P〈0．05），应用SPM分析法与正常对照进行比较，发现HD组顶枕叶代谢减低尤为显著而类似于路易体痴呆，而MD组颞顶联合区皮质、楔前叶糖代谢明显减低，与阿尔茨海默病的代谢特点一致。结论^18F—FDG PET脑显像有助于PDD的诊断及发病机制的阐述。Objective To assess the regional cerebral glucose utilization and the imaging characteristic of Parkinson＇s disease with dementia （PDD） with ^18F-fluorodeoxyglucose （FDG） positron emission tomography （PET）. Methods Questionnaire survey, mini-mental state examination （MMSE）, physical examination, and FDG PET on brain at rest state were performed on 20 patients with PDD, 13 males and 7 females, aged （70 ± 6）, and sex- and age-matched 8 patients with non-demented PD, and 30 healthy parsons. Visual inspection and statistical parametric mapping （SPM） were used to investigate the regional cerebral metabolic rate of glucose （rCMRglc） and the distribution of the tracer. Results The MMSR score of the PDD group was （27.5 ± 2.4） , （ 10 - 24） , significantly lower than those of the non-PDD group [ （27.5 ± 2.4） （22 - 30） ] and control group [ （27.9 ± 2.2） （21 - 30） ] （ F = 60.31,P = 0. 000）. There were no significant differences in Hoehn-Yahr staging and disease courses between the two PD groups （P 〉 0.05 ）. Visual inspection showed that there were no significant focal hypometabolic areas in the imaging of the non-demented PD patients, while compared to the controls, the rCMRgle levels of the PDD patients decreased in bilateral superior parietal lobules （ BA 7 ）, inferior parietal lobules （ BA 40,39 ）, superior frontal gyri （ BA 6 ）, middle frontal gyri （ BA 6,8,9 ）, middle temporal gyri （ BA 21 ）, euneate lobes （ BA 17, 18,19） ,eingulate cortices（ BA 31 ）, lingual gyri （BA 19） basal ganglia, and thalamus. According to the severity of memory impairment and the onset of hallucination, the subtype of PDD was classified into memory impairment dominant group （MD） and hallucination dominant group （HD）. The rCMRgle of MD subgroup decreased significantly in the parietotemporal association cortex, especially in the precuneus lobe. The rCMRglc of the HD subgroup decreased significantly in the occipital cortex. There were no sign

关 键 词：帕金森病 痴呆 正电子发射体层显像 氟脱氧葡萄糖 

分 类 号：R686[医药卫生—骨科学]