多巴胺D2受体乃131I-epidepride显像对帕金森病的临床研究

目的 评价多巴胺D2受体显像剂131I-(s)-(-)-N-[(1-乙基-2-吡咯烷基)甲基]-5-碘-2,3-二甲氧基苯甲酰胺(epidepride)对帕金森病(PD)的临床应用价值.方法 PD患者38例(H/YⅠ～Ⅳ级,病程4个月～6年),健康对照组12例,静脉注射131I-epidepride 18.5 MBq 3 h后行SPECT显像,并应用感兴趣区(ROI)技术计算纹状体/枕叶放射性(ST/OC)比值,分析ST/OC比值与PD患者临床严重程度的相关性.采用SPSS 10.0软件对数据进行校正t检验,配对t检验及Spearman相关分析.结果 对照组131I-epidepride显像示双侧纹状体内有高度放射性浓聚,纹状体显示清晰,双侧基本对称,额叶、颞叶、顶叶、枕叶及小脑放射性较低.与健康对照组比较,PD患者ST内131I-epide-pride浓聚增加,但差异无统计学意义.早期PD患者(H/Y Ⅰ级)病侧肢体的对侧ST放射性显著增加、体积增大(壳核尤为显著),与同侧ST相比差异有统计学意义(t=7.89,P＜0.05).ST/OC比值与PD临床严重程度(H/Y分级)无明显相关性(r=0.12,P＞0.05).结论 多巴胺D2受体131I-Epi-depride SPECT显像有助于了解PD患者ST内突触后膜的多巴胺D2受体变化,PD患者D2上调,在偏侧PD中以病变对侧壳核尤为显著.ST/OC比值与PD临床严重程度无相关性.

Clinical study of dopamine transporter imaging with 131I-epidepride for Parkinson's disease

Objective Epidepride is a novel benzamide derivative with high affinity for dopaminergic D2 receptors.It has been used to study striatal and extrastriatal D2 receptor abnormalities in humans.The aim of this study was to evaluate the level of D2 receptors in dopaminergic nitrostriatal pathway and its correlation with clinical severity in Parkinson's disease(PD).Methods Thirty-eight patients with idio-pathic PD[graded according to Hoehn and Yahr(H/Y)stage:n(Ⅰ)=13,n(Ⅱ)=11,n(Ⅲ)=8,n(Ⅳ)=6]and 12 healthy volunteers as control were included in this study.SPECT brain imaging was performed 3 h after 18.5 MBq 131I-epidepride administration.Regions of interest(ROIs)were drawn over the striatum(ST)and occipital cortex(OC).The ratios of ST to OC ROI counts(ST/OC)were calculated and correlated with clinical severity H/Y stage.SPSS 10.0 was used for data analysis,the t test and Spearman correlation analysis were used.Results ST showed intense uptake of 131I-epidepride,whereas frontal,parietal,temporal,occipital lobes and cerebellum showed low uptake in control group.Increased 131I-epide-pride uptake was observed in PD patients when compared with normal control group but without statistically significant difference.Early stage patients(hemi-PD with H/Y I)showed increased [131]I-epidepride uptake intensity and size in contralateral ST(especially caudate nucleus)significantly more than unilateral ST(t=7.89.P＜0.05).ST/OC ratio was not found to be statistically significant when correlated with the clinical severity H/Y stage(r=0.1 2,P＞0.05).Conclusions This study suggested that 131I-epidepride SPECT was useful in qualitative and quantitative evaluation of D2 receptor status in dopaminergic nigrostriatal neurons,which were over-expressed in PD patients.However,no statistically significant correlation was,found between ST 131I-epidepride binding ratios and disease severity.