^11C-PIBPET和^18F-FDGPET显像诊断阿尔茨海默病与遗忘型轻度认知损害的临床价值  

^(11)C-PIB PET and ^(18)Fer's disease a-FDG PET in patients with Alzheimnd amnestic mild cognitive impairment

作　　者：Shi Zhihong Wang Ying Liu Shuai Liu Shuling Z hou Yuying Wang Jinhuan Cai Li Gao Shuo Ji Yong 

机构地区：[1]Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin 300060, China [2]Department of Neurology, Tianjin Huanhu Hospital, Tianjin 300060, China [3]PET-CT Center, Tianjin Medical University General Hospital, Tianjin 300052, China [4]Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300060, China

出　　处：《中国现代神经疾病杂志》2014年第3期222-231,共10页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：supported by Tianjin Science and Technology Support Programs (No. 12ZCZDSY02900, 12ZCZDSY01600);Science and Technology Project of Tianjin Municipal Health Bureau (No. 11KG117);Natural Science Foundation of Tianjin (No. 13JCYBJC21300)

摘　　要：目的应用11C-PIB PET和18F-FDG PET显像研究阿尔茨海默病和遗忘型轻度认知损害患者β-淀粉样蛋白(Aβ)沉积与葡萄糖代谢之间的关系,联合载脂蛋白E(ApoE)基因型进一步探讨遗忘型轻度认知损害与阿尔茨海默病的相关性。方法利用PET显像对阿尔茨海默病(14例)、遗忘型轻度认知损害(10例)和正常对照者(5例)脑组织Aβ沉积和葡萄糖代谢变化进行分析,采用聚合酶链反应-限制性片段长度多态性方法对ApoE基因型进行分析。结果阿尔茨海默病组患者11C-PIB标准化摄取比值在下顶叶、颞叶外侧、额叶、后扣带回皮质和楔前叶、枕叶和纹状体均高于正常对照组(P<0.05);遗忘型轻度认知损害组患者脑组织11C-PIB结合水平呈双峰形。11C-PIB+aMCI亚组与阿尔茨海默病组、11C-PIB-aMCI亚组与正常对照组之间11C-PIB标准化摄取比值差异均无统计学意义(P>0.05)。18F-FDG PET显像显示,3/5例11C-PIB+aMCI亚组患者双侧顶叶、颞叶和楔前叶代谢减低,其中2例ApoEε4等位基因携带者随访期间进展至阿尔茨海默病;3/5例11C-PIB-aMCI亚组患者双侧额叶和前扣带回代谢减低。结论11C-PIB PET显像是筛查具有阿尔茨海默病病理特点的遗忘型轻度认知损害患者的有效工具。具有阿尔茨海默病病理特征的遗忘型轻度认知损害患者可伴有顶叶、颞叶外侧皮质和楔前叶代谢减低,其中ApoEε4等位基因携带者更易进展至阿尔茨海默病痴呆。Objective The present study investigated the relationship between amyloid deposition and glucose metabolism using Pittsburgh compound B （^11C- PIB） and fluorodeoxyglucose （18F- FDG） positron- emission tomography （PET） in patients with Alzheimer＇s disease （AD） and amnestic mild cognitive impairment （aMCI） and assessed the apolipoprotein E （ApoE） ε4 allele to explore the correlation between aMCI and AD. Methods Amyloid load in the brain and cerebral glucose metabolism were determined and ApoE genotypes were analyzed in patients with AD （N = 14）, aMCI （N = 10）, and healthy controls （N = 5）. Results The mean ^11C-PIB standardized uptake value ratio （SUVR） was higher in inferior parietal lobe, lateral temporal cortex, frontal cortex, posterior cingulate cortex and precuneus, occipital lobe, and striatum in AD patients compared with controls （P 〈 0.05）. uC-PIB binding levels in aMCI patients were bimodal. No significant difference in the ^111C- PIB SUVR was found between the 11C-PIB ＋ aMCI subgroup and AD group （P 〉 0.05）. ^18F-FDG PET revealed hypometabolism in bilateral parietal lobes, temporal lobe, and precuneus in 3 of 5 uC-PIB ＋ aMCI subjects, including two of them with ApoE e 4 allele converted to AD, and hypometabolism in the bilateral frontal lobe and anterior cingulate in 3 of 5 ^11C-PIB-aMCI subjects. Conclusions ~1C-PIB PET is a powerful tool for screening aMCI with AD pathology. The aMCI patients with AD pathology who presented hypometabolism in the parietal lobe, lateral temporal cortex, precuneus and with ApoE 4 allele are more likely to convert to clinical AD dementia.

关 键 词：阿尔茨海默病 认知障碍 载脂蛋白E4 放射性示踪剂 正电子发射断层显像术 

分 类 号：R749.16[医药卫生—神经病学与精神病学]