逼尿肌过度活动症患者及男性健康成人控尿状态下大脑激活区的SPECT显像

Brain SPECT Study of Detrusor Overactivity and Healthy Men in Urine Withholding

利用神经学统计图像分析软件NEUROSTAT分析健康志愿者和逼尿肌过度活动患者的SPECT图像,探讨膀胱贮尿的大脑控制区及其控制机理。15例健康志愿者(Ⅰ组)和25例下尿道尿储存功能障碍患者接受了SPECT扫描。25例中19例患者为逼尿肌过度活动症(Ⅱ组),6例患者逼尿肌功能正常(Ⅲ组)。所有受检者均在排空膀胱的静息状态和控尿状态接受SPECT扫描。控尿状态的图像用第二次扫描后的图像减去第一次的图像获得。用NEUROSTAT对比分析3组受检者在静息状态下的脑血流(rCBF)情况及各组受检者控尿状态与静息状态rCBF的差异,进行多重对照校正。静息状态下Ⅱ组与Ⅲ组相比脑血流差异无统计学意义(P>0.05)。Ⅰ组和Ⅲ组控尿状态与静息状态相比,两侧额下回和右侧颞中回rCBF明显增高,其中右侧额下回在Z-值和病灶范围方面均最为明显(多重对照校正P<0.05,Ⅰ组对应Z-值>4.476,Ⅲ组对应Z-值>4.414)。Ⅱ组控尿状态与静息状态相比,仅左侧颞中回和额中回rCBF明显增高(多重对照校正P<0.05,Ⅱ组对应Z-值>4.35)。3组结果中,没有任何病灶脑血流降低达统计学标准。本研究结果表明两侧额下回和右侧颞中回与膀胱贮尿功能的大脑控制有关,特别是右侧额下回在膀胱贮尿的大脑控制中起重要作用,抑制控尿期逼尿肌的收缩。

The aim of the study is to identify the brain areas, which control the bladder storage by 99Tc^m-HMPAO SPECT with Neurological Statistical Image Analysis Software （NEUROSTAT）. SPECT were performed on twenty-five patients with some storage symp-toms of lower urinary tract, among which nineteen patients were with detrusor overactivity （DO） （Group Ⅱ） and six patients were with normal detrusor function （Group Ⅲ）, and fifteen healthy volunteers （Group Ⅰ ）. All the subjects were male and right-handed, and were scanned twice under two conditions, resting state and urine withholding state. NEUROSTAT was adopted to analyze the difference in rCBF between groups and states. The results were displayed on Z-score images at a significance threshold of P〈0.05 with correction for multiple comparisons. No region reached significant threshold in comparison of Group Ⅱand Ⅲ in resting state. There were significant increases in tracer activity in bilateral inferior frontal gyri and the right middle temporal gyrus in urine withholding state as compared with resting state in Group I and Ⅲ （P〈0.05 with correction for multiple comparisons, the corresponding Z value was more than 4. 476 for Group Ⅰ , more than 4. 414 for Group Ⅲ）. Among the regions, the right inferior frontal gyrus was distinctly prominent at both Z-score and the extent. In Group Ⅱ , only the left middle temporal gyrus and middle frontal gyrus were activated significantly in urine withholding state as compared with resting （P〈0. 05 with correction for multiple comparisons, the corresponding Z value was more than 4.35）. The results indicated that bilateral inferior frontal gyri and the right middle temporal gyrus associated with the control of bladder storage. Especially, the right inferior frontal gyrus played a more important role in cerebral control of bladder storage, inhibiting the contraction of detrusor in urine storage.