【作者】 孙达； 张宝荣； 占宏伟； 刘洪彪； 尹风；

【Author】 SUN Da,ZHANG Bao-rong,ZHAN Hong-wei,LIU Hong-biao,YIN Feng (The Nuclear Medicine Dept,The Second Hospital of the Medical College,Zhejiang University, Hangzhou 310009,China)

【机构】 浙江大学医学院第二附属医院核医学科； 浙江大学医学院第二附属医院神经内科；

【摘要】 目的:探查Alzheimer型痴呆（AD）患者局部脑血流（rCBF）的改变及其与局部脑功能损伤的关系。方法:48例AD患者（男37例,女11例,平均年龄63.4岁,范围51～81岁）和9例正常对照者（男6例,女3例,平均年龄60.3岁,范围50～71岁）分别进行了颅脑CT/MRI检查和⁹⁹Tc^m-ECD脑血流灌注断层显像（SPECT）,观察对比脑的解剖和局部脑血流灌注（rCBF）变化,并用脑灌注显像的半定量分析方法（大脑局部感兴趣区与小脑的计数比）对大脑各部位局部脑血流的变化程度进行对比分析。结果:AD病人rCBF异常率为95.8%（46/48）,其中87.5%（42/48）表现为双侧（约占2/3）或单侧（约占1/3）颞顶部位血流灌注受损。这些病人中约70%（29/42）伴有双侧或单侧额叶rCBF减少。半定量分析的结果显示,AD病人右颢顶部位与小脑的计数比为0.516,比正常值（0.911）降低43.4%,左颞顶部位与小脑的计数比为0.526,比正常值（0.913）降低42.4%。结论:AD患者临床上表现出来的记忆和认知上的障碍及行为异常用CT和MRI是观察不到的。然而PET和SPECT所提供的功能性信息已显示,AD病人在早期就可以观察到颞顶部位的血流灌注和代谢损伤,且多为双侧对称。多数还伴有额叶的损伤。本组病例中所观察到的结果也显示,AD病人颞顶部位和额叶血流受损,反映了患者颞顶与额叶的生理活动减少、功能减退,并与其临床表现密切相关。更多还原

【Abstract】 PURPOSE Alzheimer disease（AD） is the most common type of dementia and will become increasingly prevalent with the growing elderly population.The aim of this study is to evaluate the changes of brain function in patients with AD and the value to diagnosis of AD.METHODS The change of regional cerebral perfusion was investigated using ⁹⁹Tc^m-ECDSPECT in 48 patients with AD diagnosed according to the DSM-Ⅲ-R criteria comparing with a matched control group of 15 healthy volunteers.The mean ages of the patients were 63.4（51～81） and 60.3（50～71） years old respectively. After administration of 740～925 MBq（20～25 mCi） ⁹⁹Tc^m -ECD a single photon emission tomography study was performed and then transaxial,sagittal and coronal slices were obtained.For the semiquantitative analysis of the data,the ratios of the mean counts/pixel in 24 cerebral regions to the mean counts/pixel in cerebellum were calculated respectively on three consecutive transaxial slices in the orbitomeatal plane.RESULTS 95.8 per cent of patients（46/48） had relative hypoperfusions in temporal-parietal regions 87.5%patients with AD.The temporal-parietal regions were involved bilaterally in 2/3 of them,and unilateral in 1/3 of them.70%of the patients had a significant decrease of rCBF in the bilateral or unilateral frontal lobes.The semiquantitative analysis shows CBF of right and left temporal-parietal regions decreased down for 43.45 and 42.45 respectively compared with control group.CONCLUSION According to the results of this study,patients with AD had profound dysfunction of the temporal-parietal regions bi- or unilaterally.These may reflect a decreased physiological functions of temporal-parietal cortex.and it is close correlate with the clinical feature and clinical neuropathophysiology in AD.⁹⁹Tc^m -ECD brain SPECT may may be helpful to diagnosis of AD.更多还原