^(18)F-FDG PET显像对强迫症手术治疗前后的观察  

^(18) F-FDG PET imaging before and after capsulotomy in obsessive-compulsive disorder

作　　者：管一晖[1] 孙伯民[2] 张海英[3] 林祥通[1] 左传涛[1] 赵军[1] 刘永昌[1] 

机构地区：[1]复旦大学医学院华山医院核医学科PET中心,上海200040 [2]复旦大学医学院华山医院功能神经外科,上海200040 [3]上海市精神卫生中心

出　　处：《中华核医学杂志》2001年第1期17-19,共3页Chinese Journal of Nuclear Medicine

摘　　要：目的　应用18F 脱氧葡萄糖 (FDG)PET显像评估强迫症手术治疗的疗效。方法　 9例经药物和心理治疗无效的难治性强迫症患者在术前和术后分别接受了YALE BROWN强迫症评定量表 (Y BOCS)、汉密尔顿焦虑量表 (HAMA)及FDGPET显像 ,同期的PET显像在治疗前后以相同的计数、脑定位及相同的处理条件进行采集和处理 ,患者在注射FDG时均保持相同的条件。与 10例年龄相匹配的对照者脑葡萄糖代谢进行比较 ,观察治疗前强迫症患者与对照者脑葡萄糖代谢的区别 ,并与手术治疗后的PET显像和量表评分进行比较。结果　与对照者相比 ,9例强迫症患者在额叶、扣带回、眶回、基底节尾状核头部和丘脑等处均可见FDG的高摄取。PET显像结果与YALE BROWN和HAMA量表评分结果相符。治疗后 9例患者中 6例取得良好疗效 ,其PET显像见额叶、扣带回、眶回、基底节尾状核头部和丘脑FDG代谢减低 ,且与量表评分结果一致。结论　FDGPET显像可用于解释强迫症的异常脑环路的存在 ,在治疗前有助于脑异常功能区域的定位 ,与YALE BROWN和HAMA的量表测定联合应用有助于强迫症的诊断。同时 ,FDGPET显像可用于该病的疗效观察和并发症的功能定位。Objective To evaluate the therapeutic effect of surgery in obsessive compulsive disorder(OCD) patients with 18 F FDG PET imaging. Methods 18 F fluorodeoxyglucose (FDG) PET images were obtained in 9 patients with OCD(6 male and 3 female)before and after 3 to 4 weeks of bilateral capsulotomy,PET images were also performed in 10 controls. Each OCD patient was also evaluated both before and after the surgery by various neuropsychiatric tests including Y BOCS,HAMA and HAMD. Results Compare with normal controls, 9 cases of OCD demonstrated high 18 F FDG uptake in frontal, cingulate, orbitotrontal, caudate and thalamus. After capsulotomy,6 of 9 cases showed better results, the metabolic ratios were also significant decreased in the following areas: anterior cingule gyrus: right ( P <0.001)left( P <0.05),caudate nuclei: right ( P <0.01) left ( P <0.05),anterolateral orbitofrontal cortex: right ( P <0.01) left( P <0.05),there is no significant changes in bilateral thalamus. Meanwhile ,the OCD scales also have significant decreased values in Y BOCS ( P <0.05)and HARS ( P <0.001). Conclusions These results indicated that cingule striatum pallidum thalamic circuit is closely related to OCD, and glucose metabolism in these areas decreases significantly after bilateral capsulotomy.

关 键 词：强迫症 18F-脱氧葡萄糖 PET显像 外科手术 发病机制 

分 类 号：R817[医药卫生—影像医学与核医学]