血管性帕金森综合征与帕金森病的脑多巴胺转运体代谢比较

目的比较血管性帕金森综合征(vascular parkinsonism,VP)与帕金森病(Parkinson's disease,PD)患者在脑多巴胺转运体代谢方面的差异以及鉴别诊断价值。方法筛选临床诊断VP患者12例(VP组)和Hohen-Yahr分期匹配的PD患者12例(PD组)。分别应用多巴胺转运体示踪剂~(11)C-CFT正电子发射断层显像(PET)进行脑多巴胺转运体代谢的显像,并应用感兴趣区法测定和比较基底节多巴胺转运体示踪剂摄取指数。应用急性左旋多巴负荷试验测评和比较患者的急性多巴反应性,采用国际通用PD统一评分量表(UPDRS)运动分量表,计算最大改善率。结果 VP组患者两侧壳核后部~(11)C-CFT摄取信号轻度减低,~(11)C-CFT摄取信号降低范围小于壳核横断面的后1/4区域;壳核后部信号降低的范围基本对称,左侧与右侧壳核前部、壳核后部以及尾状核头部的示踪剂摄取指数比值为0.969、1.023、0.995,两侧比较差异无统计学意义(P0.05)。Hohen-Yahr分期匹配的PD组患者首发症状,肢体对侧的壳核前部、壳核后部~(11)C-CFT摄取信号强度明显低于首发症状肢体同侧(P0.01);首发症状肢体,对侧的壳核横断面后1/2区域~(11)C-CFT摄取信号缺损。在左旋多巴-苄丝肼200/50 mg剂量水平下,VP组患者的平均UPDRS运动评分最大改善率为(13.6±7.2)%,明显低于PD组患者的平均UPDRS运动评分最大改善率(42.6±13.9)%,差异有统计学意义(P0.05)。结论 VP和PD在脑多巴胺转运体代谢和急性多巴反应性方面存在显著差异。可应用脑多巴胺转运体代谢的PET作为这2种疾病鉴别诊断的生物学标记物。

Comparison of dopamine transporter metabolism between vascular parkinsonism and Parkinson's disease

Objective To compare the metabolism pattern of dopamine transporter between vascular parkinsonism ( VP) and Hohen-Yahr stage matched Parkinson's disease (PD).Methods Twelve patients with VP and 12 patients with Hohen-Yahr stage-matched PD were enrolled in this study.The dopamine transporter tracer uptake-index in putamen,caudate nucleus and occipital cortex was assessed with ~(11)C-CFT PET.The acute challenge test with levodopa-benserazide (250/50 mg) was used to assess the improvement of Unified PD Rating Scale score.Results Mild reduction of ~(11)C-CFT uptake was observed in posterior quarter of putamen in patients with VP. The extent of reduction of ~(11)C-CFT uptake was smaller than posterior 1/4 area of cross section of putamen.There was no significant difference in reduction of ~(11)C-CFT uptake between two sides of putamen,caudate nucleus in VP.The severe reduction of ~(11)C-CFT uptake was observed in posterior half of putamen in patients with PD.The reduction of tracer uptake in posterior putamen contralateral to symptom onset side was more significant than the posterior putamen ipsilateral to symptom onset side (P < 0.01).Conclusion VP is different from PD in metabolism pattern of central dopamine transporter.The pattern may be used as diagnostic biomarker of VP.