運(yùn)用單光子發(fā)射計(jì)算機(jī)斷層掃描顯像診斷帕金森病和血管性帕金森綜

1、運(yùn)用單光子發(fā)射計(jì)算機(jī)斷層掃描顯像診斷帕金森病和血管性帕金森綜     【摘要】  目的 探討99TcmTRODAT199Tcm2N, N雙(2巰乙基)乙撐二胺基甲基,3(4氯苯基)托烷腦顯像在早期帕金森病(PD)和血管性帕金森綜合征(VP)鑒別診斷中的意義。方法 對(duì)確診的47例早期PD患者、26例VP患者和30例年齡匹配的正常對(duì)照者分別進(jìn)行99TcmTRODAT1SPECT腦顯像，應(yīng)計(jì)算機(jī)感興趣區(qū)(regions of interest, ROI)技術(shù)分別計(jì)算各組雙側(cè)紋狀體/小腦的放射性計(jì)數(shù)比值，并對(duì)結(jié)果進(jìn)行比較分析。結(jié)果 早期PD患者患肢對(duì)側(cè)

2、紋狀體對(duì)99TcmTRODAT1 的攝取減少，患肢同側(cè)和對(duì)側(cè)紋狀體/小腦的放射性計(jì)數(shù)比值均較正常對(duì)照者均值明顯降低(P<0.05)。VP患者雙側(cè)紋狀體區(qū)對(duì)99TcmTRODAT1的攝取接近正常，患肢同側(cè)和對(duì)側(cè)紋狀體/小腦的放射性計(jì)數(shù)比值與正常對(duì)照者雙側(cè)均值無(wú)顯著差異(P>0.05)。結(jié)論 99TcmTRODAT1顯像及半定量分析有助于PD的早期診斷及與VP的鑒別診斷。 【關(guān)鍵詞】  帕金森??；血管性帕金森綜合征；多巴胺轉(zhuǎn)運(yùn)蛋白；發(fā)射型計(jì)算機(jī)；單光子Differential diagnosis of Parkinson disease and vascularParkins

3、onism by single photon emissioncomputed tomography imagingABSTRACT: Objective  To investigate the differential diagnosis of earlystage Parkinson disease (PD) and vascular Parkinsonism (VP) by 99Tcm TRODAT1 single photon emission computed tomography brain imaging. Methods  99Tcm TRODAT1 SPE

4、CT brain imaging was performed on 47 patients with earlystage PD, 26 with earlystage VP and 30 agematched healthy control subjects.The radioactive ratio of striatum to cerebullum was calculated by region of interest (ROI) technique. The results were analyzed and compared. Results  The distribut

5、ion and quantities of 99Tcm TRODAT1 uptake were reduced in contralateral striatum to clinically symptomatic side of the patients with earlystage PD (P<0.05) while those were hardly different in two striatums of the patients with earlystage VP (P>0.05). The radioactive ratio of striatum to cere

6、bullum contralateral to the affected limb in the patients with earlystage PD was lower than that in the healthy control subjects while that to patients with earlystage VP were similar to that in the healthy control subjects. Conclusion  99Tcm TRODAT1 single photon emission computed tomography b

7、rain imaging and semiquantitative analysis are useful to differentiate VP from PD.KEY WORDS: Parkinson disease; vascular Parkinsonism; dopamine transporter; emission computer; single photon帕金森病(Parkinson disease, PD) 是中老年人常見的慢性、進(jìn)行性神經(jīng)系統(tǒng)變性疾病。其病理改變主要是黑質(zhì)、蒼白球、紋狀體、藍(lán)斑等神經(jīng)元的變性、缺失,殘留神經(jīng)元細(xì)胞漿內(nèi)出現(xiàn)特征性的lewy小體；黑質(zhì)多巴胺(

8、dopamine, DA) 神經(jīng)元變性丟失及黑質(zhì)紋狀體DA通路變性導(dǎo)致紋狀體DA含量顯著下降13。血管性帕金森綜合征(vascular Parkinsonism, VP)是由于高血壓病、動(dòng)脈硬化等原因引起卒中而表現(xiàn)出PD的臨床表現(xiàn)。二者的鑒別目前尚無(wú)確切的檢查手段，主要依靠病史，頭部CT和MRI也能幫助診斷一部分VP。多巴胺轉(zhuǎn)運(yùn)蛋白(dopamine transporter, DAT)是位于多巴胺神經(jīng)元突觸前膜的多巴胺再攝取位點(diǎn)，其數(shù)量間接反映了腦內(nèi)多巴胺的多少及功能。我們采用單光子發(fā)射計(jì)算機(jī)斷層顯像(single photon emission computed tomography, SP

9、ECT)，利用放射性核素標(biāo)記的特異性受體與人腦多巴胺神經(jīng)元突觸前膜DAT的高度親和性，進(jìn)行腦DAT顯像，試圖鑒別PD和VP。1  資料與方法1.1  研究對(duì)象  73例患者均為2004年6月至2006年8月在我院神經(jīng)內(nèi)科就診者，其中PD組47例，男31例，女16例，年齡47-72歲，平均(56.5±9.8)歲，均符合1984年全國(guó)錐體外系疾病討論會(huì)提出的診斷標(biāo)準(zhǔn)4；VP組26例，男18例，女8例，年齡53-75歲，平均(55.1±7.2)歲，診斷根據(jù)卒中病史、影像學(xué)檢查及1984年全國(guó)錐體外系疾病討論會(huì)提出的診斷標(biāo)準(zhǔn)4，除外化學(xué)藥物、中毒、外傷

10、及其他原因引起的帕金森綜合征。所有患者均為改良HoehnYahr分期1期和1.5期，在行SPECT檢查當(dāng)天停服抗PD藥。對(duì)照組為年齡與之匹配的正常對(duì)照者30例，男18例，女12例，年齡49-71歲，平均(54.2±10.5)歲，均除外精神、神經(jīng)疾患及腦損傷、腦手術(shù)等病史，經(jīng)臨床及CT檢查確定為健康者。1.2  試劑與儀器  99TcmTROADT1 99Tcm 2N, N雙(2巰乙基)乙撐二胺基甲基,3(4氯苯基)托烷藥盒(江蘇省原醫(yī)學(xué)研究所)；氯化亞錫(廣州化公司)；99Tcm O4 新鮮淋洗液(中國(guó)原子能科學(xué)研究院)；SPECT 儀(Siemens公司生產(chǎn)的D

11、iacam系統(tǒng))。1.3  99TcmTRODAT1的制備  將新鮮配制的氯化亞錫溶液(200mg/L)及99TcmO-4新鮮淋洗液(3700MBq/mL) 先后加入TRODAT1凍干藥盒中，于100水浴煮沸30min，冷卻至室溫即得99TcmTRODT1 5。1.4  圖像采集與分析  患者口服過(guò)氯酸鉀400mg，30min后由肘靜脈注射99TcmTRODAT1 740MBq (20mci)，注射2-3h后用SPECT儀進(jìn)行圖像采集。在重建的腦橫斷面圖像上選取紋狀體顯示最為清晰的4個(gè)層面進(jìn)行半定量分析，利用計(jì)算機(jī)感興趣區(qū)(regions of interest, ROI)技術(shù)在患者和正常對(duì)照者相應(yīng)層面上均設(shè)置相同大小的ROI，分別勾畫出雙側(cè)紋狀體和小腦的ROI，經(jīng)計(jì)算機(jī)自動(dòng)處理分別獲取相應(yīng)部位的每像素平均放射性計(jì)數(shù)，然后分別計(jì)算每一側(cè)紋狀體與腦的放射性計(jì)數(shù)比值R6，代表相應(yīng)側(cè)紋狀體的特異性99TcmTRODT1攝取和DAT功能水平。1.5  統(tǒng)計(jì)學(xué)處理  放射性計(jì)數(shù)比值比較的統(tǒng)計(jì)檢驗(yàn)采用SPSS 10.0軟件包行非配對(duì)t檢驗(yàn)，P<0.05為差異有統(tǒng)計(jì)學(xué)意義。2  結(jié)果2.1  各組SPECT圖像比較&#