多巴胺转运体基因多态性与帕金森病的易感性及PET/CT显像

目的探讨多巴胺转运体(DAT)基因3'非翻译区可变串联重复序列(VNTR)多态性与内蒙古地区帕金森病(PD)的相关性并分析其机制。方法选取PD患者52例为PD组,健康体检人员60例为对照组。对DAT基因的3'非翻译区VNTR进行基因分型;对20例PD患者和10例对照者进行11C-甲基-N-2β-甲基酯-3β-(4-F-苯基)托烷(11C-β-CFT) DAT正电子发射计算机断层显像(PET)-CT脑显像。结果 VNTR有9R和10R两个等位基因,VNTR的基因型频率和等位基因频率在对照组和PD组差异无统计学意义(P0. 05)。对照组DAT显像清晰,双侧尾状核、前壳核和后壳核11C-β-CFT放射性摄取均匀对称。PD组尾状核、前壳核和后壳核11C-β-CFT放射性摄取指数与对照组比较显著下降,差异有统计学意义(P0. 05)。结论 DAT基因VNTR多态性与内蒙古地区PD无明显相关性,VNTR多态性与PD患者纹状体11C-β-CFT放射性摄取无明显相关性。     

不对称静止性震颤患者脑多巴胺转运体代谢分析

目的本研究拟通过脑多巴胺转运体的正电子发射断层显像(PET)对不对称静止性震颤患者进行脑多巴胺转运体代谢特点进行分析,以指导临床诊断。方法筛选出不对称静止性震颤患者40例,每例受试者均进行脑~(11)C-甲基-N-2β-甲基酯-3β-(4 F-苯基)托烷(~(11)C-β-CFT)PET。根据PET结果 ,分为2组,无多巴胺能系统功能缺失的分子影像学证据(SWEDD)组6例,非SWEDD组34例。比较2组间临床特征的差异,分析不对称静止性震颤患者脑多巴胺转运体代谢的特点。结果 SWEDD组双侧纹状体对脑多巴胺转运体对比剂~(11)C-β-CFT摄取对称完整。非SWEDD组11例表现为纹状体对~(11)C-β-CFT不对称性摄取下降,23例表现为纹状体对~(11)Cβ-CFT对称性摄取下降。SWEDD组患者平均病程明显高于非SWEDD组[(9.42±11.40)年vs(3.64±2.70)年,P<0.05]。结论不对称静止性震颤患者的脑多巴胺转运体代谢存在异质性,部分患者扫描为SWEDD。进行脑多巴胺转运体分子影像学检查有助于鉴别SWEDD和帕金森病患者。     

~(18)F氟脱氧葡萄糖正电子发射断层显像鉴别阿尔茨海默病和额颞叶痴呆的价值

目的探讨~(18)F-氟脱氧葡萄糖(~(18)F-FDG)正电子发射断层显像(positron emission tomography,PET)/CT对阿尔茨海默病(AD)和额颞叶痴呆(FTD)的鉴别诊断价值。方法回顾性分析临床诊断为AD 20例和FTD 10例的~(18)F-FDG PET/CT脑代谢显像资料,采用脑代谢影像进行视觉分析,测量相应部位的标准摄取值(standard up take value,SUV),以小脑为参考脑区,以放射性摄取减低脑区的SUV与小脑SUV的比值(SUVr)表示。采用NeuroQ脑分析软件进行定量分析其代谢模式特点。结果 20例AD患者视觉分析显示,16例(80.0%)伴有双侧顶叶代谢减低,8例(40.0%)伴有双侧颞叶代谢减低,5例(25.0%)伴有单侧额叶代谢减低,2例(10.0%)伴有单侧颞叶代谢减低;定量分析显示,全部患者(100.0%)均伴有双侧顶叶代谢减低,18例(90.0%)伴有后扣带回代谢减低,17例(85.0%)伴有双侧颞叶代谢减低,7例(35.0%)伴有单侧额叶代谢减低。10例FTD患者视觉分析显示,8例(80.0%)患者伴有颞叶代谢减低,6例(60.0%)患者伴有额叶代谢减低,3例(30.0%)伴有双侧顶叶代谢减低;定量分析显示,10例患者(100.0%)均伴有额叶代谢减低,8例(80.0%)伴有颞叶代谢减低,4例(40.0%)伴有双侧顶叶代谢减低,4例(40.0%)伴有基底节代谢减低,3例(30.0%)伴有后扣带回代谢减低。AD患者和FTD患者额叶、顶叶和颞叶SUVr比较,差异有统计学意义(1.08±0.13 vs 0.75±0.09,0.78±0.14 vs 1.06±0.05,0.81±0.14 vs 0.95±0.12,P<0.01)。结论 ~(18)F-FDG PET/CT脑显像显示的AD和FTD患者不同的代谢减低模式,有助于临床进行鉴别诊断。     

18F-脱氧葡萄糖单光子发射计算机断层显像鉴别阿尔茨海默病及额颞叶痴呆的临床研究

目的 探讨阿尔茨海默病(Alzheimers disease,AD)及额颞叶痴呆(Frontotemporal dementia,FTD)患者18 F-脱氧葡萄糖(18F-deoxyglucose,18F-FDG)单光子发射计算机断层显像(SPECT)的特点。方法 选择2014年12月~2015年10月在首都医科大学宣武医院核医学科就诊并诊断为AD和FTD的患者29例,按诊断分为AD组19例,其中男性8例,女性11例,平均年龄(61.57±7.46)岁;FTD组10例,其中男性6例,女性4例,平均年龄(62.80±7.53)岁。同期选健康老年人9例为对照组,其中男性4例,女性5例,平均年龄(60.11±10.79)岁。所有研究对象行18F-FDG的SPECT检查。结果 对照组双侧大脑皮质、丘脑和基底节区未见异常放射性浓聚、稀疏或缺损。AD组和FTD组患者与对照组相比,18F-FDG的SPECT检查均表现为皮质代谢减低。AD组15例双侧大脑皮质对称性减低,其中40.00%顶、颞叶皮质代谢对称性明显减低;33.3%双侧顶叶皮质代谢对称性明显减低;13.33%伴有双侧额叶皮质代谢对称性减低。FTD组8例对称性减低,其中50%双侧额叶皮质代谢对称性明显减低。Fisher确切概率法检验显示,AD组和FTD组患者的SPECT脑代谢表现具有显著统计学差异(P0.05)。结论18F-FDG的SPECT能够为临床鉴别诊断AD和FTD提供客观的影像学依据。     

阿尔茨海默病β淀粉样蛋白水平监测:11C-PIB PET/CT显像沉积量与血浆水平的相关性研究

目的探讨血浆β淀粉样蛋白(Aβ)水平与~(11)C-PIB PET/CT显示的淀粉样蛋白沉积的相关性。方法选择在沈阳军区总医院接受治疗的阿尔茨海默病(AD)患者、轻度认知障碍(MCI)患者和无痴呆健康正常对照(NC)老年人共计69例,各组均行~(11)C-PIB PET/CT显像和血浆Aβ42和Aβ40检测,勾画额叶、外侧颞叶、顶叶皮层、楔前叶/后扣带回和前扣带回5个感兴趣的区域,测量全脑和各个感兴趣区域的Aβ标准化摄取值(SUV),分析其与血浆Aβ42和Aβ40水平的相关性。采用SPSS 18. 0软件进行数据分析。结果 NC、MCI和AD组Aβ42/Aβ40标准化摄取值比(SUVR)逐渐下降,~(11)C-PIB SUVR值逐渐上升,差异均有统计学意义(P 0. 05)。血浆Aβ42水平、Aβ42/Aβ40与~(11)C-PIB PET显像SUVR值呈负相关(r_(Aβ42)=-0. 461,r_(Aβ42/Aβ40)=-0. 633),血浆Aβ40与~(11)C-PIB PET显像SUVR值呈正相关(r=0. 430),差异均有统计学意义(P 0.05)。3组相比,各脑区11C-PIB SUVR值逐渐升高,回归分析表明,额叶、外侧颞叶和楔前叶/后扣带回~(11)C-PIB SUVR可由血浆Aβ42/Aβ40比值预测,差异具有统计学意义(P 0. 05),而顶叶和后扣带回的PIB结合与Aβ42/Aβ40比值关系不具有统计学意义(P 0.05)。结论血浆Aβ42/40比值可预测脑淀粉样蛋白沉积水平。~(11)C-PIB PET Aβ沉积量与血浆Aβ42/Aβ40比值作为生物标志物具有潜在临床意义。     

肥厚型心肌病患者核素心肌灌注/代谢显像的研究

目的:观察肥厚型心肌病(HCM)患者的核素心肌灌注/代谢显像的变化,以进一步揭示HCM的病理生理改变,为今后患者的预后分析提供基础.方法:采用单光子发射计算机断层成像双核素心肌灌注/代谢显像的方法对93例(男65例,女28例,年龄16~68岁)HCM患者行99mTc-甲氧基异丁基异腈(99mTc-MIBI)心肌灌注显像和18F-脱氧葡萄糖(18F-FDG)心肌代谢显像.患者均为空腹状态下,静脉注射99mTc-MIBI 20 mCi、18F-FDG 4 mCi,1小时后行双核素心肌显像.采用半定量评分法分析左心室室壁各节段的灌注及葡萄糖显像情况.结果:93例HCM患者99mTc-MIBI心肌灌注显像结果:左心室心肌放射性摄取增高患者90例(97%),其中间隔部82例,前壁20例,心尖部15例,外侧壁4例,下后壁3例.93例HCM患者18F-FDG心肌代谢显像结果:31例(33%)患者心肌未见明显显影;13例(14%)患者左心室显影清晰,左心室室壁各心肌节段均可见放射性摄取或明显摄取(得分为-1或-2);49例(53%)患者心肌部分节段有放射性分布,其中间隔36例,前壁35例,心尖部20例,外侧壁33例,下后壁32例.结论:肥厚型心肌病患者心肌灌注/代谢显像异常表现具有多样性,灌注显像的异常主要表现为心肌放射性摄取增高,最多累及部位为间隔部;而代谢显像表现不均一性较为明显,左心室室壁各心肌节段约可见放射性摄取的患者有14%,心肌部分节段可见放射性摄取的患者有53%,而左心室心肌各节段均未见放射性摄取的占33%.     

病程对老年2型糖尿病患者认知功能及相关危险因素的影响

目的观察病程对老年2型糖尿病患者认知功能及相关危险因素的影响。方法选择2型糖尿病患者172例,按病程分为3组:糖尿病A组(病程<10年)60例,糖尿病B组(病程10~19年)67例,糖尿病C组(病程≥20年)45例,同期入选的糖耐量异常组(空腹血糖受损及糖耐量减低)41例,对照组68例。均行头颅CT和颈动脉超声检查。结果糖尿病C组颈动脉不稳定性斑块(64.4%vs 36.8%,P<0.01;64.4%vs 36.6%,P<0.01)、腔隙性脑梗死(84.4%vs 61.8%,P<0.01;84.4%vs 65.9%,P<0.05)和脑白质病变比例(62.2%vs 35.3%,P<0.05;62.2%vs 36.6%,P<0.05)明显高于对照组和糖耐量异常组。糖尿病C组胰岛素或其类似物治疗比例明显高于糖尿病A组(42.2%vs 15.0%,P<0.05)。糖尿病C组他汀类物治疗、轻度认知功能障碍和痴呆比例明显高于对照组(77.8%vs 54.4%,20.0%vs 2.9%,8.9%vs 0%,P<0.05)。logistic回归分析显示,糖尿病病程≥20年、颈动脉狭窄和胰岛素或其类似物治疗预示患者轻度认知功能障碍和痴呆的可能(P<0.05,P<0.01)。结论糖尿病病程≥20年的患者更易出现轻度认知功能障碍、痴呆,同时并发腔隙性脑梗死、脑白质病变和颈动脉不稳定性斑块比例增高。     

非霍奇金淋巴瘤患者脑葡萄糖代谢改变的统计参数图分析

目的探讨非霍奇金淋巴瘤(NHL)患者脑葡糖糖代谢改变的特点。方法回顾性分析解放军总医院2015年1月至2016年5月95例未经治疗的体部NHL患者和60例健康体检者脑部~(18)氟-脱氧葡萄糖(~(18)F-FDG)正电子发射计算机断层显像(PET/CT)图像,通过统计参数图(SPM)软件在一定显著性水平(P0.001)和体素阈值(K=125体素)下分析NHL患者与60例健康体检者、以及14例60岁和81例≤60岁NHL患者脑部葡萄糖代谢改变的特征和脑区分布。结果与对照组相比,NHL患者未发现代谢增高的脑区,但存在多个脑区的葡萄糖代谢减低,减低区主要位于部分双侧枕叶、左侧额下回、双侧中央前回,且左侧葡萄糖代谢减低区域的范围较右侧更广泛。60岁NHL组和≤60岁NHL组相比,60岁NHL患者脑部葡萄糖代谢出现减低区和增高区,减低区主要存在于双侧额叶,增高区主要存在于双侧小脑。结论 NHL患者脑葡糖糖代谢减低并非全脑性分布,而是以区域性葡萄糖代谢减低为特征,涉及脑区可能与患者的精神情感功能及免疫改变有关。60岁NHL患者葡萄糖代谢减低区域更广泛,可能与脑老化改变相关。     

肺吸虫病18F-FDG PET-CT显像1例并文献复习

目的探讨肺吸虫病18F-氟脱氧葡萄糖(18F-FDG)PET-CT全身显像的临床价值。方法通过对1例肺吸虫病例的临床资料、18F-FDG PET-CT全身影像及相关文献的复习研究,分析该病的临床特点及全身PET-CT表现。结果 PET-CT全身扫描发现双肺内多发云絮状、结节状病灶,FDG摄取明显增高,SUVmax(2.4～9.0),延迟扫描后进一步升高SUVmax(3.15～11.2),部分病灶内见空洞及附壁结节,双侧胸膜增厚粘连伴少量胸腔积液,两肺门及纵隔肿大淋巴结。此外还发现食管下段及胃壁FDG摄取增高,肝内多发斑片状FDG摄取增高灶,肝门部多发高代谢肿大淋巴结。结论18F-FDG PET-CT全身显像不仅很好地显示肺内病灶的分布、形态、密度及代谢特征,且能更好地发现肺外组织、器官的受累,为肺吸虫病的诊断和病情评估提供有用信息。     

分子影像学在阿尔茨海默病诊断及鉴别诊断中的价值

目的探讨11 C标记的匹兹堡复合物B正电子发射断层显像(11 C-PIB-PET)在阿尔茨海默病(AD)诊断及鉴别诊断中的价值。方法选择不同类型痴呆患者11例,其中AD患者6例,路易体痴呆(DLB)患者2例,额颞叶变性(FTLD)患者2例,血管性痴呆(VaD)患者1例,另选智能正常老年人10例。所有入选者行11 C-PIB-PET,采集受试者图像并进行分析。结果 AD患者11 C-PIB-PET视觉观察下皮质放射性滞留明显,各脑区与小脑标准吸收值之比2.63~3.08,正常老年人、DLB、FTLD、VaD患者11 C-PIB-PET视觉观察下皮质放射性滞留不明显,且各脑区与小脑标准吸收值之比相似。结论 11 C-PIB-PET在AD诊断及鉴别诊断中有重要临床应用价值。     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.