Hohen—YahrⅡ期帕金森病患者多巴胺转运体代谢与急性多巴胺能反应性的相关性研究

The relationship between metabolism of dopamine transporter and levodopa-responsiveness in Parkinson＇s disease patients of Hohen-YahrⅡ

目的研究帕金森病（PD）患者的多巴胺转运体代谢与多巴胺能反应性是否具有相关性。方法选择13例Hohen—YahrⅡPD患者，分别应用急性阶梯式左旋多巴／苄丝肼（50．0／12．5、100．0／25．0、150．0／37．5mg）试验评价患者的急性多巴胺能反应性，应用甲酯基托品烷衍生物（11C．CFT）PET研究基底节区的多巴胺转运体代谢变化。分析服用左旋多巴后PD患者的统一PD评分量表运动分量表（UPDRSⅢ）评分改善率与基底节区多巴胺转运体示踪剂“C—CFF摄取强度的相关性。结果13例PD患者首发症状肢体对侧的壳核后部11C-CFT摄取信号缺损，11例患者首发症状肢体同侧的壳核后部11C—CFT摄取信号部分缺损。首发症状肢体对侧的壳核后部11C-CFT摄取信号强度低于首发症状同侧，差异有统计学意义（P〈0.01）。PD患者在左旋多巴／苄丝肼100．0／25．0mg和150．0／37．5mg剂量水平的UPDRS运动评分最大改善率与首发症状对侧壳核后部11C-CFT摄取信号强度的r值分别为0．513和0．572（P均〈0．01）；与首发症状同侧壳核后部11C-CFT摄取信号强度的r值分别为0．452和0．478（P均〈0．05）；与基底节其他感兴趣区11C-CFT摄取信号强度无相关性（P〉．0．05）。结论Hzhen—YahrⅡ期PD多巴胺转运俸代谢与多巴胺能反应性这两种生物学标记物具有相关性，有助深入了解PD的病理生理过程。

Objective To investigate the relationship between metabolism of dopamine transporter and levo- dope-responsiveness in patients with Parkinson＇s disease（PD）. Methods Thirteen patients with PD of Hohen-Yahr stage Ⅱ were enrolled in this study. The acute consecutive levedopa/benserazide （50.0/12, 5 mg, 100.0/25.0 mg, 150.0/37.5 mg） tests were used to assess the patients＇ motor responses. The dopamine transporter binding were assessed with 11C-CFT PET specific in putamen,caudate uucleus and occipital cortex. The correlation between the improvement of UPDRS Ⅲ and 11C-CFT PET the uptaking capability was analyzed. Results The marked reduction of 11C-CFT uptake was observed in posterior putamen in patients with PD. The reduction of tracers uptake in posterior putamen coutralateral to onset side was more significant than the posterior putamen ipsilateral to onset side （ P 〈 0.01 ）. There was significant correlation between 11C-CFT uptake in posterior putamen contralateral to onset side and the improvement of UPDR5 motor subscale in test with levedopa/benserazide 100.0/25.0 mg or 150.0/37.5 mg （r = 0.513, r = 0. 372, P 〈 0.01 ）. There was also significant correlation between 11C-CFT uptake in posterior putsmen ipsilateral to onset side and the improvement of UPDRS motor aubscale in test with levedopa/benserazide 100.0/25.0 mg or 150.0/37.5 mg （ r = 0. 452, r = 0.478, P 〈 0.01 ）. There was no correlation between 11C-CFF uptake in basal ganglia and the improvement of UPDTRS motor subseale in test with levedopa/benserazide 100/25 mg or 150/37.5 mg（ P〉 0. 05 ）. Conclusion There is correlation between metabolism of dopamine transporter and levedopa responsivencss PD patients of Hohen-Yahr Ⅱ,which is helpful for the investigation of the pathophysiology.