脑多巴胺转运体SPECT显像鉴别早期帕金森病与原发性震颤  

Differentiating the early Parkinson's disease from essential tremor by using dopamine transporter SPECT imaging in patients' brain

作　　者：陈玲[1] 胡平[2] 黎锦如[1] 刘焯霖[1] 吴克宁[2] 潘勇辉[1] 李春亿[2] 李纬明[2] 

机构地区：[1]中山大学附属第一医院神经科,广州510080 [2]中山大学附属第一医院核医学科,广州510080

出　　处：《中华神经科杂志》2003年第6期414-417,共4页Chinese Journal of Neurology

基　　金：国家自然科学基金资助项目 (3 9670 2 2 9)

摘　　要：目的　探讨脑多巴胺转运体99mTc TRODAT 1SPECT显像在鉴别帕金森病与原发性震颤的应用。方法　 19例帕金森病与 17例原发性震颤患者均行脑多巴胺转运体99mTc TRODAT 1SPECT显像 ,勾画出两组患者脑内感兴趣区 (双侧纹状体及小脑 ) ,计算机自动给出各区的放射性计数 ,计算左、右侧纹状体的特异性放射性摄取比值及不对称指数并加以比较。结果　帕金森病患者的Hoehn Yahr分期是 1 7± 0 6。原发性震颤患者脑多巴胺转运体对99mTc TRODAT 1的特异性摄取比值左 (0 5± 0 1)、右 (0 6± 0 2 )两侧差异无显著意义 ;而帕金森病患者症状对侧 (0 3± 0 2 )与症状同侧 (0 4± 0 2 )差异有显著意义 ,症状对侧低 ,症状同侧高 ,并且双侧均低于原发性震颤患者。不对称指数帕金森病患者 (2 1 1± 17 4 )明显高于原发性震颤 (9 2± 11 2 )患者。结论　脑多巴胺转运体99mTc TRODAT 1SPECT显像可以鉴别帕金森病与原发性震颤。Objective To search a simple and convenient method for use in the clinical discrimination. Methods Dopamine transporter imaging of SPECT with 99m Tc-TRODAT-1 was used to differentiate the early Parkinson’s disease from the essential tremor.36 patients from outpatient Department of Neurology in our hospital were enrolled.19 of them were patients with Parkinson’s disease, and 17 with essential tremor.Those with Parkinson’s were conducted of Hoehn-Yahr classification at first.All 36 patients in two groups were performed with dopamine transporter imaging using SPECT with 99m Tc-TRODAT-1 in their brains.The regions of interesting including bilateral striatum (ST) and cerebellum (CB) were figured.And radioactivity counts (N) of three regions (N_ ST.L for left striatum, N_ ST.R for right striatum and N_ CB for cerebellum) were found by computer automatically.At last the ratios (R) of specific radioactivity uptake (R=N_ ST /N_ CB -1) and asymmetry indexes {AI, AI=(R_L-R_R)×100/[(R_L+R_R)/2]} of the two groups were calculated and compared. Results The Hoehn–Yahr stage in Parkinson’s disease was 1.7±0.6, that stands for early stage.The ratios of specific radioactivity uptake in essential tremor group was 0.5±0.1 (left) and 0.6±0.2 (right).The difference was not significant( P >0.05).The ratios of specific radioactivity uptake in Parkinson’s disease group was 0.3±0.2 (side contralateral to onset or more severe limb) and 0.4±0.2 (ipsilateral side).The difference between them was significant ( P <0.05).The bilateral ratios of Parkinson’s disease group differed significantly from that of essential tremor group ( P <0.01 for contralateral side, P <0.05 for ipsilateral side).Asymmetry index was 9.2±11.2 in essential tremor group and 21.1±17.4 in Parkinson’s disease group respectively.The difference was significant ( P <0.05).Conclusion The dopamine transporter SPECT imaging with 99m Tc-TRODAT-1 can be used in the differential diagnosis of early Parkinson’s disease and essential tremor.

关 键 词：多巴胺转运体 SPECT显像 鉴别诊断 早期帕金森病 原发性震颤 纹状体多巴胺 

分 类 号：R742.5[医药卫生—神经病学与精神病学] R814.42[医药卫生—临床医学]