Alzheimer病颞顶叶低灌注的研究  

Studies of temporoparietal hypoperfusion in patients with Alzheimer's Disease

作　　者：昂秋青[1] 江开达[1] 林祥通 金少津 张明园[1] 

机构地区：[1]上海市精神卫生中心,200030 [2]复旦大学附属华山医院核医学科

出　　处：《中华核医学杂志》2001年第5期263-265,共3页Chinese Journal of Nuclear Medicine

基　　金：上海市医学领先专业老年精神医学重点学科建设基金资助项目 (95 III 0 1 1 )

摘　　要：目的　了解Alzheimer病 (AD)脑血流灌注的病理性变化与健康老年人增龄性改变的区别 ,以及颞、顶叶低灌注对判断AD程度的意义。方法　对照组为 73例健康老年人 ,AD组 6 0例 ,2组均按年龄再分为 6 0～ 6 5岁组 ,～ 70岁组和 70岁以上组。均行SPECT脑血流灌注显像。结果　右顶叶灌注在 6 0～ 6 5岁、～ 70岁组间差异有显著性 (P <0 .0 1)。AD组双侧颞叶、顶叶和额叶血流灌注较对照组显著下降。AD 3个年龄组所有感兴趣区的放射性比值均无明显差异。 6 0～ 6 5岁组中AD左颞叶、双侧顶叶和双侧额叶灌注明显低于对照组 ;70岁以上组中 ,AD双侧顶叶和额叶灌注显著低于对照组。以双侧顶叶灌注指标为变量作凝聚法分层聚类分析 ,AD可分为 3类 ,I类 (subad1) :31例 ,简易智力状态检查量表 (MMSE)为 2 0～ 2 4分 ;II类 (subad2 ) :2 2例 ,MMSE为 13～ 19分 ;III类 (subad3) :7例 ,MMSE为 5～ 11分。结论　AD脑血流灌注下降的范围和幅度均较增龄性变化大 。Objective To understand the differences of brain perfusion changes in patients with Alzheimer's disease (AD) and healthy elders and to find out which is pathological and which is biological. To figure out the significance of low perfusion in temporal and parietal lobes to AD. Methods Sixty AD patients were assigned to 3 age groups: 60～65 years old (ad1), 66～70 (ad2) and over 70 (ad3). Seventy three healthy elders were also assigned to 3 age groups as nor1, nor2 and nor3. Sixty AD patients and all control subjects were examined with SPECT. Results Significant differences ( P <0.01) were found in perfusion at right parietal lobes between nor2 and nor1. Perfusions at bilateral temporal ( P <0.05), parietal ( P <0.01) and frontal ( P< 0.01) lobes were significantly lower in AD patients than in controls. There were no significant difference in SPECT measures at all regions of interest among 3 AD age groups. In 60～65 group, perfusions at left temporal (P <0.05), bilateral parietal ( P <0.01), left frontal (P <0.01) and right frontal ( P <0.05) lobes were significantly lower in AD patients than in controls; in over 70 group, perfusions at bilateral parietal (P< 0.01)and frontal (P <0.01) lobes were significantly lower in AD patients than in controls. All of the AD patients were categorized into 3 sub groups, in hierarchical cluster analysis through agglomeration, with bilateral parietal perfusion index as variate: sub group I (subad1): 31 cases, MMSE scored from 20～24; sub group II (subad2): 22 cases, MMSE 13～19; sub group III (subad3): 7 cases, MMSE 5～11. Conclusions The extent and magnitude of cerebral blood hypoperfusion in AD patients were much more severe than in normal age related changes in healthy controls. Bilateral parietal perfusion could be adopted as an effective categorical measure for AD patients at various severity.

关 键 词：阿尔茨海默病 局部血流 SPELT 

分 类 号：R749.16[医药卫生—神经病学与精神病学]