阿尔茨海默病与路易体痴呆的脑葡萄糖代谢比较

目的 比较阿尔茨海默病与路易体痴呆在脑葡萄糖代谢方面的特征.方法 本研究入选了28例阿尔茨海默病(AD)患者和25例路易体痴呆(DLB)患者.受试者静脉注射示踪刺18F脱氧葡萄糖(18F-FDG),然后接受头部正电子发射断层扫描(PET).应用迭代法重建的脑图像,分别取额叶皮层、顶叶皮层、颞叶皮层、枕叶皮层、小脑皮层、尾状核头、壳核为感兴趣区(ROI).以脑内各ROI与小脑半球ROI的FDG摄取强度的比值为指标进行分析和比较.结果 AD在颞叶前部、顶叶皮层FDG摄取下降,额、顶、颞、枕叶、壳核、尾状核皮层感兴趣区与小脑皮层的FDG代谢比值分别为(0.861±0.173)、(0.625±0.149)、(0.598 ±0.185)、(0.914±0.214)、(1.030 ±0.084)、(0.997±0.102);DLB在额叶前部皮层、颞叶前部皮层、顶叶后部皮层、纹状体的FDG摄取均下降,额、顶、颞、枕叶、壳核、尾状核皮层感兴趣区与小脑皮层的FDG代谢比值分别为(0.538±0.147)、(0.615±0.138)、(0.587 ±0.142)、(0.415 ±0.107)、(0.685 ±0.094)、(0.547 ±0.103).DLB在枕叶皮层、额叶皮层、纹状体的FDG摄取下降比AD显著,差异有统计学意义(P均＜0.01).结论 AD与DLB在皮层和基底节的葡萄糖代谢特征存在显著差异.这些特征有助于两者的鉴别诊断.

Comparison of cerebral glucose metabolism between Alzheimer's disease and dementia with lewy bodies

Objective To investigate the feature of cerebral glucose metabolism of Alzheimer's disease (AD)and dementia with lewy bodies (DLB).Methods 28 patients with AD and 25 patients with DLB underwent positron emission tomography (PET)with 18 F-fluorodeoxyglucose (18F-FDG)showing glucose metabolism.The region of interest (ROI)was selected from frontal cortex,temporal cortex,parietal cortex,occipital cortex,cerebellum cortex and corpora striata.The 18 F-FDG metabolism ratios between various cerebral regions and cerebellum cortex were compared as an indicator of regional cerebral glucose metabolic patterns.Results The FDG metabolism ratio of parietal cortex and temporal cortex decreased similarly in AD.The FDG metabolism ratio of frontal cortex,parietal cortex,temporal cortex,occipital cortex,dorsal caudate putamen and caudate nucleus in AD was (0.861 ± 0.173),(0.625 ± 0.149),(0.598 ± 0.185 ),(0.914 ± 0.214),( 1.030 ± 0.084)and ( 0.997 ± 0.102 )].The FDG metabolism ratio of frontal cortex,parietal cortex,occipital cortex,temporal cortex and corpus striatum decreased similarly in DLB.The FDG metabolism ratio of frontal cortex,parietal cortex,temporal cortex,occipital cortex,dorsal caudate putamen and candate nucleus in DLB was (0.538 ±0.147),(0.615 ±0.138),( 0.587 ±0.142),(0.415 ±0.107 ),(0.685 ± 0.094)and (0.547 ± 0.103 )].The FDG metabolism ratio of frontal cortex,occipital cortex and corpus striatum decreased more significantly in DLB than in AD (P＜0.01 ).Conclusion There are discrepancies in cerebral glucose metabolism between AD and DLB.These features may be useful in differential diagnosis of these two kinds of dementia.