11C-PIB PET在不同时期阿尔茨海默病中的研究进展

阿尔茨海默病(AD)作为神经变性病, 起病隐袭, 早期诊断困难。β淀粉样蛋白(Aβ)沉积形成的老年斑是其特征性病理改变, 并且发生在疾病的早期阶段。N-[11C]甲基-2-4′-甲基氨基苯基-6-羟基苯并噻唑(11C-PIB)作为Aβ特异性的分子探针, 能够无创、实时、定量地监测脑内纤维状Aβ的变化。因此, 明确PIB在不同时期AD中的分布特点, 对AD的早期诊断、抗Aβ治疗的人群筛选以及疗效监测方面都具有重要意义。该文就近年来11C-PIB PET在不同时期AD中的应用作一综述。     

轻度认知功能障碍及Alzheimer病的SPECT研究进展

老年性痴呆(Alzheimer病,AD)的起病隐袭,确诊只能依靠尸检.因此,AD的早期诊断及准确鉴别是当今急待解决的课题.轻度认知功能障碍(MCI)被认为是AD的超早期阶段,如能早期预测MCI向AD的转化,有助于尽早采取合理的干预措施.近年来,单光子发射计算机断层(single photon emission computed tomography, SPECT)在MCI、AD的早期诊断、鉴别诊断及预后方面的价值日益受到重视.通过静脉注射锝-99m-六甲基丙烯胺肟(99mTc-HMPAO), 99mTc-双半胱乙酯(99mTc-ECD)作为显像剂, SPECT可测定局部脑血流(rCBF).     

PET分子探针在阿尔茨海默病早期诊断中的研究进展

阿尔茨海默病(AD)是最常见的痴呆类型,并随着人口老龄化将会变得越来越普遍.在AD 出现临床症状前数十年脑内就可发生病理改变,临床诊断标准不能准确诊检轻度AD及无症状AD.AD的早期诊断越来越受到重视,对发生在AD早期的不可逆性神经损伤前的干预治疗尤为重要.神经影像标志物是最有发展前途的诊断早期AD的方法,PET功能性...     

阿尔茨海默病相关的神经丝蛋白的早期诊断价值

目的 探讨一种简便、可靠、无损伤、特异性较强的早期诊断阿尔茨海默病(alzheimer disease,AD)的方法.方法 采用酶联免疫吸附法(ELISA)测定尿液中神经丝蛋白(alzheimer associated neuronal thread protein,AD7c-NTP)的含量,并比较38例AD患者与35例年龄相匹配的健康对照组尿中的AD7c-NTP的含量;同时分析尿中AD7c-NTP含量与智能精神状态检查量表(MMSE)、临床痴呆评定量表(CDR)和日常生活能力量表(ADL)评分的相关性.结果 AD组与对照组尿液中AD7c-NTP含量分别为(90.78±16.54)ng/ml、(70.63±12.56)ng/ml,AD组明显高于健康对照组,差异有统计学意义(P＜0.05);AD组尿液AD7c-NTP含量与MMSE、CDR、ADL分数变化有一定相关性,相关系数分别为0.756、-0.658、-0.760.结论 测定尿液中AD7c-NTP含量在AD早期诊断和病情评估中有重要的临床参考价值.     

嗅觉脑功能MRI对阿尔茨海默病的早期诊断

目的 探讨嗅觉功能MRI早期诊断阿尔茨海默病(AD)的价值.资料与方法 14例正常老年人(NC)、11例轻度认知障碍(MCI)患者及12例AD患者进行MMSE、MOCA及CDR量表评分,采用西门子3.0T磁共振扫描仪、32通道头线圈以事件相关设计的方式进行嗅觉fMRI扫描,64位Matlab 7.11.0及SPM8软件进行数据处理,选择双侧初级嗅觉皮层(POC)为感兴趣区(ROI),统计ROI内激活体素数量并进行分析,比较3组间ROI内的激活体素数量,分析受试者ROI内的激活体素数量与MMSE和MOCA评分的相关性.结果 NC组、MCI组和AD组POC内激活体素数分别为201±114、88±102、45±60,AD组激活水平显著低于MCI组及NC组,MCI组显著低于NC组,差异有统计学意义(H=13.272,P＜0.01).控制年龄因素时,受试者初级嗅觉皮层内的激活范围与MMSE评分(r=0.447,P＜0.05)及MOCA评分(r=0.421,P＜0.05)呈正相关.结论 嗅觉功能MRI可以反映AD病理改变造成的嗅觉功能损害,可能成为早期诊断AD的新方法,具有重要研究价值.     

11C-PIB PET在监测阿尔茨海默病患者淀粉样蛋白沉积中应用价值研究

目的 探讨11 C-PIB PET在监测阿尔茨海默病(AD)患者淀粉样蛋白沉积中的应用价值.方法 回顾性分析北部战区总医院2018—2021年收治的9例疑似未确诊AD者的临床资料,包括简易智力状态检查(MMSE)评分、11 C-PIB PET显像情况等,分析MMSE评分与PIB摄取的相关性.结果 首次11 C-PIB ...     

阿尔茨海默病脑脊液标志物与淀粉样蛋白PET诊断相关性研究

目的 探讨阿尔茨海默病(AD)脑脊液标志物与11 C-PIB PET/CT淀粉样蛋白显像诊断的相关性.方法 选取北部战区总医院2013—2021年收治的27例AD患者和29例轻度认知障碍(MCI)患者为研究对象.所有患者均接受11 C-PIB PET/CT显像和腰椎穿刺.根据β淀粉样蛋白(Aβ)沉积,将患者分为PET阳...     

新型斑块显像剂18F-W372在阿尔茨海默病中的应用

目的 通过比较18F-7-甲氧基-2(6-氟-18吡啶-3-yl)咪唑[2,1-β]-8-吡啶噻唑(18F-W372)和11C-匹兹堡化合物B(11C-PIB)在AD患者和健康老年志愿者(HC)的动态影像,评价新型斑块显像剂18F-W372的临床应用价值.方法 8例AD患者,年龄(64.00±8.81)岁,男∶女=1∶7;9名HC,年龄(64.78±4.02)岁,男∶女=4∶5;2名青年志愿者,男29岁,女25岁.静脉注射18F-W372和11C-PIB后,进行40 min连续动态PET数据采集.计算每个受试者SUV以及皮质/小脑SUV比率(SUVR),获得2种示踪剂TAC.应用秩和检验及两样本t检验进行统计学处理.结果 AD患者简易智力状态检查量表(MMSE)评分低于HC,为19.13±4.05与28.89±0.78(T=36.00,P＜0.01).AD与HC受试者年龄(H=28.50,P＞0.05)及受教育程度(H=35.50,P＞0.05)差异无统计学意义.18F-W372能够快速通过血脑屏障并迅速廓清.AD患者在皮质区域出现18F-W372摄取,而青年志愿者仅有少量摄取.给药40 min内,18F-W372和11C-PIB在AD患者皮质/小脑SUVR进行性增加,但后者更加明显.两者均出现白质区放射性浓聚,但18F-W372在白质的摄取明显高于皮质.35～40 min时,AD患者和HC11C-PIB和18F-W372皮质/小脑SUVR分别为1.48±0.22与1.06±0.04(t=5.58,P＜0.001)和1.31±0.08与1.17±0.06(t=3.78,P＜0.01).结论 18F-W372与11C-PIB具有相似分布模式,在注射18F-W372 40 min内SUVR在AD患者与HC间有差异,但视觉上病灶欠清晰.18F-W372作为斑块显像剂临床应用有待进一步深入研究.     

早期阿尔茨海默病脑白质改变和认知功能损伤的相关性

目的 探讨早期阿尔茨海默病(AD)脑白质变化与认知功能改变的关系.方法 对14例早期AD患者(AD组)和18名健康老年人(ON组)在1.5 T MR扫描仪上进行扩散张量成像(DTI)扫描.在9个感兴趣区测量并比较各向异性分数(FA)和平均扩散系数((-D)).对2组研究对象进行8个标准的神经心理测试,以评价其基本认知能力状态,并对测试结果 进行比较.分析所有研究对象DTI的FA和(-D)测量结果 与神经心理测试评分的相关性.结果 与ON组相比,AD患者在胼胝体压部(分别为0.25±0.03和0.49±0.03)和后顶-颞叶(分别为0.30±0.02和0.28±0.01)FA降低(t值分别为2.481、1.991,P值均＜0.05)、在胼胝体压部D提高(t=1.751,P＜0.05).在8个神经心理行为测试中,AD患者的评分均低于ON组(t值2.803～4.691,P值均＜0.05).相关性研究结果 显示,AD患者胼胝体压部和后顶-颞叶的FA与多个神经心理测试评分呈正相关(r值0.355～0.499,P值均＜0.05),而在较分散的多个部位(-D)与多个神经心理测试评分呈负相关(r值-0.518～-0.350,P值均＜0.05).结论 在AD早期阶段,患者不仅有认知功能的改变,而且还有白质结构的变化,两者存在一定的相关性,表现为脑白质的选择区域性损害,这种损害反映了AD病理机制中皮质间联系的丢失.     

主动脉夹层分离的超声检查36例临床分析

主动脉夹层分离(AD)是种极为严重的血管疾病,早期不易确诊,主动脉夹层分离的确诊主要依靠影像学,包括胸片、主动脉造影、CT、MRI及超声心动图等.超声对AD的诊断有一定帮助,而且能早期在床边进行,现将我院1998年～2000年应用彩色多普勒检查对36例疑诊AD患者进行分析.     

Tau蛋白的异常翻译后修饰与阿尔茨海默病

阿尔茨海默病（Alzheimer’s disease，AD）是一种发生在老年期及老年前期的神经退行性疾病，其主要的病理改变包括老年斑、神经元纤维缠结和神经元脱失。由于以磷酸化和糖基化为主的Tau蛋白异常翻译后修饰与神经元纤维缠结关系密切，因此，关于Tau蛋白在AD发生发展中的作用已成为近年AD研究领域的一大热点。本文重点对目前有关Tau蛋白异常翻译后修饰与AD的关系，以及Tau蛋白在AD诊断中的作用和以其为靶标进行AD防治药物研究的现状和前景进行了综述。     

Memorcise and Alzheimer’s disease

Alzheimer’s disease (AD) is a debilitating disease influencing a multitude of outcomes, including memory function. Recent work suggests that memory may be influenced by exercise (‘memorcise’), even among those with AD. The present narrative review details (1) the underlying mechanisms of AD; (2) whether exercise has a protective effect in preventing AD; (3) the mechanisms through which exercise may help to prevent AD; (4) the mechanisms through which exercise may help attenuate the progression of AD severity among those with existing AD; (5) the effects and mechanisms through which exercise is associated with memory among those with existing AD; and (6) exercise recommendations for those with existing AD. Such an understanding will aid clinicians in their ability to use exercise as a potential behavioral strategy to help prevent and treat AD.     

阿尔茨海默病KIBRA基因多态性及其相关影像遗传学研究

遗传因素在阿尔茨海默病（AD）发生中具有重要作用。近年来的研究显示,肾脑表达蛋白（KIBRA）基因多态性能够增加AD风险,在AD的重要脑区（如海马）出现高表达,与晚发型AD有显著相关性。形态学MRI研究显示KIBRA基因多态性与海马关系密切,但该基因多态性的多种功能成像研究存在不一致性,其神经机制尚不明确。应用影像遗传学方法,探索KIBRA基因多态性对AD大脑功能及对行为的潜在作用将有助于了解遗传风险因素对AD的影响,为早期诊断AD提供依据,进而对疾病早期有效干预以及相关药物的研发提供重要线索。     

Alzheimer disease and other dementias

This article offers an overview of Alzheimer disease (AD) and its differential diagnosis from other dementias. After completing it, readers will: Be familiar with the prevalence of AD and other dementias. Summarize the major causes of dementia. Understand the basic pathology of AD. Recognize the common cognitive and noncognitive symptoms of AD. Identify the risk factors for AD and methods to prevent the disease. Describe the evaluation and diagnosis of AD. Discuss the role of structural and functional imaging in dementia diagnosis. Know how physicians manage AD symptoms. Assimilate this knowledge for use in encounters with patients with Alzheimer disease.     

MRI-based quantitative assessment of the hippocampal region in very mild to moderate Alzheimer's disease

We investigated the hippocampal region in six patients diagnosed with possible Alzheimer's disease (AD), eight patients with probable AD, and eight agematched controls, using a high-resolution magnetic resonance imaging technique. Coronal T1-weighted images were used for area measurements of the hippocampal formation (HF), parahippocampal gyrus (PHG), and temporal lobe (TL), normalised to cranial area. Both the normalised HF and PHG were significantly smaller in both AD groups than in the controls, but did not differ between patients with possible and probable AD. The normalised TL was significantly smaller in patients with probable AD than in those with possible AD and controls, but did not differ in patients with possible AD and controls. We conclude that hippocampal and parahippocampal atrophy occurs in early AD, and is more useful than neocortical atrophy for early detection of the disease. At a more advanced stage, the neocortical area is involved.     

阿尔茨海默病PET正电子药物应用与研究进展

阿尔茨海默病（AD）严重危害人们的身心健康。伴随PET分子成像的发展,出现了一系列针对AD的正电子药物,其中匹兹堡化合物B（PIB）及其衍生物类PET正电子药物研究最为成熟,部分已获准应用于临床,在AD诊断与治疗方面显示出重要价值。随着人们对AD发生机制研究的不断深入,近年又相继出现了包括蛋白类、受体类以及肽类在内的更多种类AD相关PET正电子药物。该文就此类正电子药物的应用与研究进展做一综述。     

Alzheimer's dementia, sleep disorders and nuclear medicine

In case new diagnostic procedures for Alzheimer's dementia (AD) appear, Nuclear Medicine (NM) would like to be aware of them in order to evaluate its own contribution to diagnose AD by SPET and PET brain studies. Recently, sleep disturbances were studied in AD and tend to be diagnostic for early AD. In AD the actual time of night sleep was found to be 5.7 h, while awakeness time for the same night sleep increased to 2.7 h. Also in AD, the REM and the slow wave stage (SWS) during sleep are shorter and hypopnea and apnea phases are abundant. Internal body temperature during night sleep is only slightly increased in AD, while in temporofrontal dementia and in normal individuals this increase is significant. The circadian rhythm of melatonin is disturbed in AD. The normal duration of inspiration and expiration during daytime which is reversed during normal night sleep, has not been studied in patients with AD. However, this reverse condition favoring inspiration is expected to provide more oxygen to the brain. Chronic but not acute stress causes memory loss and is currently being studied by us as a possible causative factor for memory loss in AD. Tomographic SPET and PET brain studies can locate the site of brain damage in AD. This is important since memory has recently been classified into four categories, namely episodic, semantic, procedural and working memory. In early AD only procedural memory remains intact. This means that these patients may drive a car, do computer word processing and play some games at home or/and in the field. This memory is located in specific nuclei in the cerebellum and the occipital frontal area which do not relate to sites of other kinds of memory. This difference could be well identified by tomographic SPET or PET studies. Thus NM may also diagnose the early stage of AD. Another issue refers to the indications that the unified Medicare and Medicaid system in the USA has issued on September 15, 2004 for performing a PET (18)F-FDG study for AD. These indications are fully described in this editorial.     

Alzheimer病乳头体MRI体积测量研究

目的:探讨Alzheimer病(Alzheimer disease,AD)所致的乳头体(mammillary body,MB)体积变化趋势及其临床应用价值。方法:收集AD神经影像项目正常、轻度认知功能障碍(mild cognitive impairment,MCI)和AD患者的颅脑MRI资料各25例,重复测量MB体积2遍,取均值为测量体积,取双侧测量体积之和为测量总体积,后行标准化处理。对MCI、AD组按照侧别、性别分别进行配对样本t检验、独立样本t检验;正常对照、MCI、AD组间进行单因素方差分析,如存在差异则进行两两比较。结果:MCI、AD组MB体积存在侧别差异,均为右侧大于左侧;3组MB体积均无性别差异。正常对照组、MCI组及AD组间MB体积、总体积有差异,3组间侧别MB体积亦有差异,均为正常对照组>MCI组>AD组。结论:MB体积萎缩出现于AD早期,与病变进程相一致,可作为AD早期较为敏感的脑体积变化指标,但特异性差;AD中MB受损呈非对称性,左侧萎缩较右侧明显。     

阿尔茨海默病相关正电子显像剂的研究进展

阿尔茨海默病（AD）是老年人群中最常见的神经退行性疾病之一,其症状始于轻微的记忆困难,逐渐演变为认知功能障碍、复杂的日常活动功能障碍等。目前AD的早期诊断和鉴别诊断仍具有一定的挑战性,而β淀粉样蛋白（Aβ）和Tau蛋白等生物标志物在AD诊断中的作用越来越重要。笔者就AD诊断相关的正电子显像剂进行综述,以期让更多的医务工作者了解新的核医学显像技术,从而对AD进行早期诊断和治疗,延缓病情的恶化。