脑多巴胺转运体显像在诊断帕金森病中的应用  

Application of DAT SPECT for diagnosing and assessing idiopathic parkinson's disease

作　　者：史国华[1,2] 楼岑[1,2] 黄中柯[1,2] 

机构地区：[1]浙江大学医学院附属卲逸夫医院核医学科 [2]浙江大学邵逸夫临床医学研究所,浙江杭州310016

出　　处：《全科医学临床与教育》2008年第5期369-371,374,F0002,共5页Clinical Education of General Practice

摘　　要：目的研究99mTc-TRODAT-1多巴胺转运体(DAT)SPECT显像诊断和评价帕金森病(PD)严重程度的意义。方法对12例健康自愿者、38例帕金森病患者行99mTc-TRODAT-1SPECT断层显像,利用感兴趣区方法在横断层上应用半定量的计算机感兴趣区技术分别勾画最清楚的连续三层,取其平均值计算帕金森病患者和健康对照者的纹状体(尾状核、壳核)与本底[(小脑+枕叶)/2]部位的DAT比值,分别代表相应部位的多巴胺转运蛋白功能水平。对PD患者进行UPDRS评分和Hoehn-Yahr分级。结果帕金森病患者双侧纹状体的多巴胺转运蛋白功能均低于健康对照者,差异有统计学意义(t分别=31.51、27.99,P均<0.05),并以患侧肢体或最先受累肢体对侧多巴胺转运蛋白功能降低为甚,差异有统计学意义(t=4.80,P<0.05),尤其是在Hoehn-YahrI期帕金森病患者。使用相关分析表明DAT摄取比值同UPDRS评分、Hoehn-Yahr分级都存在良好的相关性(t分别=12.45、2.21,P均<0.05)。结论99mTc-TRODAT-1SPECT脑显像为提高帕金森病的诊断准确性提供了一种行之有效的手段,对于评价帕金森病的严重程度有益。Objective To investigate the role of ^99mTc-TRODAT-1 SPECT in diagnosis and assessing severity of idiopathic Parkinson＇s disease （PD）. Methods Thirty-eight patients with a primary, tentative diagnosis of PD assessed by the rating scale Hoehn ＆ Yahr （ HYS ） and 12 age-matched normal controls were studied with ^99mTc- TRODAT-1 SPECT imaging. The regions of interests （ROIs） were drawn manually on cerebellum （CB）, occipital cortex （OC） and three consecutive plane slice-views of striatums, and the semiquantitative BG/[（OC ＋ CB）/2] were then calculated. The classification of PD patients was used by the rating scale Hoehn ＆ Yahr. Results A greater loss of DAT uptake was found in striatum and its subregions contralateral striatum to the affected limbs of PD cases than in those of controls （ t=31.51, 27.99, P〈0.05）. The DAT levels of striatum and its subregions were reduced obviously contralteral side more than that of ipsilateral side to the affected limb in HYS I PD patients particularly （t=4.80, P〈0.05）. Using spearman correlation analysis, the reduction of the uptake ratios significantly correlated with the rating scale of UPDRS, Hoehn ＆ Yahr in striatums and its all subregions in the PD group （ t=- 12.45, 2.21, P〈0.05）. Conclusions ^99mTc-TRODAT-1 SPECT imaging may serve as a useful method for improving the correct diagnosis of PD.

关 键 词：^99MTC-TRODAT-1 帕金森病 SPECT 多巴胺转运蛋白 DAT 

分 类 号：R742.5[医药卫生—神经病学与精神病学] R734.2[医药卫生—临床医学]