特发性正常压力脑积水经脑室-腹腔分流术后不同脑区^(18)F-FDGPET表现特点  

Characteristics of ^(18)F-FDG PET in different brain areas after idiopathic normal pressure hydrocephalus underwent ventriculoperitoneal shunt

作　　者：连泽豪 王新伟[1] 袁尧 薛文俊[1] LIAN Zehao;WANG Xinwei;YUAN Yao;XUE Wenjun(The First People’s Hospital of Pingdingshan,Pingdingshan 467000,China;General Hospital of Pingmei Shenma Group,Pingdingshan 467000,China)

机构地区：[1]平顶山市第一人民医院,河南平顶山467000 [2]平煤神马集团总医院,河南平顶山467000

出　　处：《中国实用神经疾病杂志》2021年第16期1427-1435,共9页Chinese Journal of Practical Nervous Diseases

基　　金：河南省医学科技攻关计划项目(编号:LHGJ20191262)。

摘　　要：目的探讨特发性正常压力脑积水经脑室-腹腔分流术后的短期临床表现特点及不同脑区^(18)F-氟脱氧葡萄糖(^(18)F-FDG)正电子发射断层扫描(PET)成像表现特点。方法以平顶山市第一人民医院收治的38例特发性正常压力脑积水患者为研究对象进行前瞻性研究,所有患者采用腹腔镜辅助下的脑室-腹腔分流术,对比患者术前和术后1个月的临床表现,包括简易精神状态量表(MMSE)评分、蒙特利尔认知评估量表(MoCA)评分、3m计时起立行走试验(TUG)、日本特发性正常压力脑积水分级评分(iNPHGS)以及额叶功能评定量表(FAB)评分,同时利用^(18)F-FDGPET分析不同脑区葡萄糖消耗量变化,并分析与各临床表现的相关性。结果与VPS术前相比,术后1个月患者MoCA评分(19.96±5.01vs14.93±4.63)、FAB评分增高(14.37±2.76vs9.14±3.18),TUG(16.72±3.81vs22.00±5.71)、INPHGS(6.67±2.59vs9.41±1.33)评分降低,差异均有统计学意义(P<0.05)。VP术后患者左额叶(1.19±0.10vs1.03±0.09)、左顶叶(1.31±0.21vs0.29±0.09)葡萄糖代谢增加,而右额叶(1.21±0.11vs1.33±0.09)葡萄糖代谢降低,差异均有统计学意义(P<0.05)。相关性分析显示,左顶叶葡萄糖代谢增长比分别与MoCA评分增长比、FAB评分增长比以及iNPHGS评分减少比呈正相关(P<0.05)。结论经腹腔镜辅助下行脑室-腹腔分流术患者认知功能改善与脑皮质相应功能区的葡萄糖代谢增加有关。Objective To investigate the characteristics of^(18)F-FDG PET in different brain areas after idio⁃pathic normal pressure hydrocephalus underwent ventriculoperitoneal shunt.Methods Totally 38 cases of patients with idiopathic normal pressure hydrocephalus admitted in our hospital were selected as the research objects,all patients treated with laparoscopic assisted ventricle peritoneal shunt,compare the clinical manifestations,including simple mental state scale(MMSE)score,Montreal cognitive assessment scale(MoCA)score,3m time to stand up to walk test(TUG),Japanese idiopathic normal pressure hydrocephalus classification score(iNPHGS)and frontal lobe function rating scale(FAB)score before and after operation for 1 month.At the same time,^(18)F-fluorodeoxy⁃glucose(^(18)F-FDG)positron emission tomography(PET)imaging was used to analyze the changes of glucose con⁃sumption in different brain regions,and the correlation with various clinical manifestations was analyzed.Results Compared with those before VP,MoCA score(19.96±5.01 vs 14.93±4.63)and FAB score(14.37±2.76 vs 9.14±3.18)were increased one month after VP,and TUG(16.72±3.81 vs 22.00±5.71)and INPHGS scores(6.67±2.59 vs 9.41±1.33)were decreased,and the differences were statistically significant(P<0.05).After VPS,glucose metabo⁃lism in the left frontal lobe(1.19±0.10 vs 1.03±0.09)and left parietal lobe(1.31±0.21 vs 0.29±0.09)increased,while decreased in the right frontal lobe(1.21±0.11 vs 1.33±0.09),all with statistically significant differences(P<0.05).The correlation analysis showed that the glucose metabolism growth ratio of the left parietal lobe was posi⁃tively correlated with the MoCA score growth ratio,FAB score growth ratio and iNPHGS score reduction ratio re⁃spectively(P<0.05).Conclusion The improvement of cognitive function in patients undergoing laparoscopic-as⁃sisted ventriculoperitoneal shunt is associated with increased glucose metabolism in the corresponding functional areas of the cerebral cortex.

关 键 词：特发性正常压力脑积水 脑室-腹腔分流术 认知障碍 步态 ^(18)F-FDGPET 葡萄糖代谢 

分 类 号：R742.1[医药卫生—神经病学与精神病学]