阿尔茨海默病脑白质葡萄糖代谢异常分析

The study of the abnormality of metabolism rate of glucose of cerebral white matter in Alzheimer's disease

目的探讨阿尔茨海默病(AD)脑白质葡萄糖代谢异常的意义。方法纳入33例符合美国精神障碍诊断与统计手册-第四版(DSM-IV)AD诊断标准的患者和健康对照20名,进行脑正电子发射断层成像(PET)检查。应用SPM软件对PET图像进行分析。结果①与健康对照相比,AD患者有广泛的白质葡萄糖代谢减低,减低较为明显的区域有右侧额叶皮质下白质、左侧额叶上中回皮质下白质(P<0.001);另外,AD患者左侧额叶内侧回皮质下白质、左侧枕叶楔回皮质下白质葡萄糖代谢增强(P<0.001);②与不伴有精神行为症状(BPS)的AD患者(16例)相比,伴有BPS的AD患者(17例)在左右枕叶中回、右侧枕叶楔回、右侧顶下小叶、左侧颞叶梭形回、左侧额叶内侧回等脑区的皮质下白质葡萄糖代谢增强(P<0.001);而左右额叶中央旁回、右侧额叶上回和中回、左侧颞叶上回等脑区的皮质下白质葡萄糖代谢减低(P<0.001)。结论AD有广泛的白质脑葡萄糖代谢异常,有无BPS的AD白质代谢异常不同。

Objective To study the abnormality of cerebral metabolism rate of glucose （CMRglc） of cerebral white matter in Alzheimer＇s Disease （AD）. Methods The positron emission tomography （PET） was performed in 33 AD patients and 20 healthy controls. Among the 33 patients, 17 have behavioral and psychological symptoms （BPS） and 16 have no BPS. The regional CMRglc （rCMRglc） of some brain regions and nucleus were detected. The PET images were compared between the two groups with statistic parameter mapping （SPM） pixel by pixel. Results In comparison with the healthy controls, the AD patients had decreased rCMRglc of cerebral or subcortical white matter in the following areas： broadly in whole areas, especially in the right frontal lobe, the superior gyrus of the left frontal lobe, the left medial prefrontal lobe, and the left cuneus of occipital lobe （P 〈0. 001 ）. The AD patients with BPS than those without BPS had less rCMRglc of subcortical white matter on paracentral lobule of both side and the left superior temporal lobe, but had higher rCM- Rglc on the middle occipital lobe of both side, the right cuneus of occipital lobe, the right inferior parietal lobule, the left fusiform gyrus of temporal lobe, and the left medial prefrontal lobe （ P 〈 0. 001 ）. Conclusions The AD patients are abnor- mal on the rCMRglc of cerebral or subcortical white matter broadly on all areas, especially in some lobe. The patients with BPS are different on the rCMRglc of cerebral or subcortical white matter from those without BPS.