【摘要】 目的:应用脑部单光子发射型计算机扫描多巴胺转运体显像技术,分析帕金森病的病情严重程度与大脑双侧纹状体多巴胺转运体放射性摄取分布变化的相关性。方法:①选取2005-01/11广州中医药大学附属第二医院收治的帕金森病患者30例,均符合英国帕金森病协会脑库Hoehn-Yahr分级临床诊断标准。根据Ⅰ级:单侧患病;Ⅱ级:双侧患病,但无平衡障碍;Ⅲ级:双侧患病,伴有早期的姿势平衡障碍;IV级:严重患病,需要较多的帮助;Ⅴ级:没有他人帮助时,只能生活在床上或轮椅上的标准评估,30例患者早期(Ⅰ～Ⅱ级)11例,中期(Ⅲ级)9例,晚期(Ⅵ～Ⅴ级)10例。同时选择6例健康体检者作为正常对照。②30例患者在停服抗帕金森病药物24h后,连同6例健康体检者各自口服过氯酸钾400mg,静卧30min后由肘静脉注射99Tcm-TRODAT-1740MBq,注射完毕后用脑部单光子发射型计算机扫描仪进行图像采集。③矩阵为64×64,每探头旋转180°,1帧/60s。双探头共采集64帧,采集计数为50K/帧。选择纹状体图像最清晰的断层,计算机自动对起病同侧及对侧纹状体区域的尾状核、壳核前后区、丘脑区的感兴趣区进行放射性计数,取平均值作为患者起病同侧及对侧各区放射性计数的象素均值。结果:实验选取帕金森病患者30例,另以6例健康体检者作为正常对照,全部进入结果分析。正常人与帕金森病患者大脑双侧各区放射性摄取的比较:①正常人大脑双侧纹状体有高浓度放射性摄取,双侧纹状体区域的尾状核、壳核前后区和丘脑区结构清晰,放射性分布左右对称,周围脑组织本底很低。②早期帕金森病患者起病对侧壳核前后区放射性摄取减少(t=15.82,P=0.000<0.05),双侧的尾状核和丘脑区结构清晰,放射性分布左右对称(t=1.19,P=0.25>0.05;t=-0.80,P=0.43>0.05)。③中期帕金森病患者双侧的壳核前后区和丘脑区放射性摄取均显著减少,兴趣区放射性平均计数差异显著(t=5.20,P=0.001<0.05;t=3.95,P=0.004<0.05);起病对侧的尾状核结构欠清晰,放射性分布较同侧减少(t=14.65,P=0.000<0.05)。④晚期帕金森病患者大脑双侧纹状体结构不清,放射性摄取明显减少,周围本底增高,甚至高过整个纹状体分布。结论:采用脑部单光子发射型计算机扫描多巴胺转运体,显像诊断双侧纹状体各部位放射性摄取明显减少,有助于帕金森病的诊断及严重程度的评估。更多还原

【Abstract】 AIM: To analyze the correlation between the severity of Parkinson disease (PD) and the distribution of radioactivity uptake of dopamine transporter (DAT) in cerebral bilateral striatum by means of single photon emission computer tomography (SPECT). METHODS: ①Thirty PD patients treated at the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from January to December in 2005 were adopted in the study, and accorded with the clinical diagnosis standard of British PD Association (Hoehn-Yahr staging: Ⅰ: unilateral involvement; Ⅱ: bilateral involvement without balance disorders; Ⅲ: bilateral involvement with postural balance disorders; Ⅳ: severe involvement in need of much help; Ⅴ: only living in beds or wheel chairs without others’ help). Among 30 PD patients, 11 ones were evaluated as early period (Ⅰ-Ⅱ), 9 ones as middle period (Ⅲ) and 10 ones as later period (Ⅳ-Ⅴ). Meanwhile, 6 healthy physical examinees were taken as normal controls.②After administrating anti-PD drugs for 24 hours, 30 PD patients went on to take orally 400 mg potassium perchlorate, identically as 6 controls. And then all the testees were scanned with SPECT by injecting 99Tcm-TRODAT-1 740 MBq via elbow veins after lying for 30 minutes.③Matrix 64×64, 180° rotation for each detector head, and 60 s each frame. Totally 64 frames were collected by double detector heads, 50 K in each frame. SPECT was applied to conduct radioactive counts on the region of interest (ROI) in caudate nucleus, putamen and thalamus, and the mean value was considered as the pixel mean of the radioactive count in unilateral and bilateral involvements. RESULTS: Totally 30 PD patients and 6 normal controls entered into the result analysis. Comparison of radioactivity uptakes in various cerebral regions between normal controls and PD patients:①Normal controls appeared high-concentrated radioactivity uptakes, symmetric distribution and clear structure in caudate nucleus, putamen and thalamus of bilateral striatum, and low background in surrounding cerebral tissues.②PD patients at early period showed decreased radioactivity uptakes in putamen of bilateral striatum (t=15.82, P=0.000 < 0.05), and symmetric distribution, clear structure in caudate nucleus and thalamus of bilateral striatum (t=1.19, P=0.25 > 0.05; t=-0.80, P=0.43 > 0.05).③PD patients at middle period demonstrated significantly decreased radioactivity uptakes in putamen and thalamus of bilateral striatum and significant differences in mean value of radioactive count between ROI (t=5.20, P=0.001 < 0.05; t=3.95, P=0.004 < 0.05); In addition, they had unclear structure and reduced radioactivity distribution in caudate nucleus (t=14.65, P=0.000 < 0.05).④PD patients at later period illustrated unclear structure, obviously decreased radioactivity uptakes and increased surrounding background in bilateral striatum. CONCLUSION: It is helpful to diagnose the obviously decreased radioactivity uptakes in various regions of bilateral striatum by SPECT DAT image for the diagnosis and severity evaluation of PD patients.更多还原