神经精神狼疮患者局部脑血流灌注显像的临床研究  

Clinical application of regional cerebral blood flow SPECT imaging in systemic lupus erythematosus patients complicated with neuropsychiatric disorders

作　　者：邱娟[1] 梁昌华[2] 左晓霞[3] 邓豪余[2] 谭政良[2] 

机构地区：[1]中南大学湘雅二三医院核医学科,长沙410013 [2]中南大学湘雅医院核医学科 [3]中南大学湘雅医院风湿病科

出　　处：《中华风湿病学杂志》2009年第3期172-174,共3页Chinese Journal of Rheumatology

摘　　要：目的观察神经精神狼疮患者脑血流改变，探讨神经精神狼疮患者局部脑血流灌注（rCBF）显像的临床意义。方法20例神经精神狼疮患者（NPSLE组）、20例无神经精神表现的狼疮患者（SLE组）和20名年龄相当的健康志愿者（健康组）行单光子发射计算机断层（SPECT）rCBF显像，并划取感兴趣区作半定量分析得半定量（HQ）值。比较各组SPECTrCBF显像结果，并对HQ结果进行分析。同时20例神经精神狼疮患者行CT／磁共振成像（MRI）显像并与rCBF显像进行对比。结果NPSLE组患者rCBF显像均阳性100％，其中19例局部脑血流降低，1例局部脑血流增加；20例患者CT／MRI头部显像阳性4例（20％），同rCBF显像相比差异有统计学意义（P〈0．01）。SLE组患者rCBF显像阳性1例（5％），表现为局部脑血流降低。20名健康志愿者rCBF显像未见异常。NPSLE组患者rCBF显像病灶主要分布在颞叶（36％）、额叶（18％）。其颞叶、额叶HQ值与SLE对照组和健康对照组比较，差异有统计学意义（P〈0．01和P〈0．05）。结论rCBF显像灵敏度高，对早期诊断和治疗神经精神狼疮有重要意义。神经精神狼疮患者。CBF显像多表现为局部脑血流降低，好发部位为大脑中动脉供血区，以颞叶、额叶多见。Objective To observe the changes of regional cerebral blood flow （rCBF） in systemic lupus erythematosus （SLE） patients with neuropsychiatric disorders and evaluate rCBF SPECT imaging in the detection of neuropsychiatric problems in SLE patients. Methods Twenty neuropsychiatric SLE patients were enrolled in the study and were performed SPECT rCBF imaging and CT/MRI scans, respectively. Twenty SI,E patients without neuropsychiatric manifestations （SLE） and 20 healthy volunteers also underwent SPECT rCBF imaging as controls. Semiquantitative analysis was conducted as designed by selecting 3 consecutive crosssections and delineating ROI, which generated HQ and the results were compared between with SLE and controls. Results SPECT rCBF findings were abnormal in 20 NPSLE, in which 19 of the 20 with abnormal SPECT findings showed focal uptake defects the other patient showed increased focal uptake. Four NPSLE patients had abnormal CT/MRI scans findings. Compared with the methods of rCBF and CT/MRI imaging, the difference was significant （P〈0.01）. Nineteen SLE patients without neuropsychiatric manifestations had normal SPECT findings, the other 1 patient showed focal uptake defect. SPECT findings were all normal in 20 healthy volunteers. Tetoporal cortex was the most commonly involved region, followed by frontal cortex. Specific values generated from semiquantitative analysis （HQ） of temporal and frontal regions in neruopsychiatric SLE patients were lower than that in SLE patients and heahhy volunteers （P〈0.01 and P〈0.05 ）. Conclusion SPECT rCBF imaging has the potential to be a sensitive tool to detect the neuropsychiatric disorders in SLE patients, and has important value in helping for early diagnosis and therapy. Hypoperfusion on ECD-SPECT under the territory of the middle cerebral artery （MCA） is the most common observation,, and which temporal and frontal regions are the most frequently involved regions in neruopsychiatric SLE patients.

关 键 词：狼疮血管炎 中枢神经系统 体层摄影术 发射型计算机 单光子 局部血流 

分 类 号：R686[医药卫生—骨科学]