阿尔茨海默病脑区葡萄糖代谢研究

The study of glucose metabolism of cerebral regions in Alzheimer disease

目的:探讨阿尔茨海默病(AD)患者部分脑区葡萄糖代谢增强的原因及意义。方法:符合美国精神障碍诊断和统计手册第4版(DSM-4)诊断标准的AD患者33例(AD组),其中17例伴有痴呆精神行为症状(BPSD),16例不伴有BPSD;以20名健康人作对照(对照组)。两组均进行一般资料、简易智能状态(MMSE)、日常生活能力及Hachinski缺血指数量表测定,并进行脑正电子发射断层成像(PET)检查;应用SPM2000软件对两组PET图像进行基于像素的比较。结果:与对照组相比,AD患者左侧额叶内侧回皮质下白质,左侧枕叶楔回灰质(Brodmann17区)及皮质下白质,右侧小脑扁桃体等脑区葡萄糖代谢显著增强(P<0.001);与不伴有BPSD的AD患者相比,伴有BPSD的AD患者额叶、顶枕叶及颞叶下部等脑区的葡萄糖代谢显著减低(P<0.001),而枕叶、小脑等脑区的代谢显著增强(P<0.001)。结论:无论是否伴有BPSD的AD患者,其脑葡萄糖代谢均有弥漫性减低,但部分脑区呈代谢增强,增强区域主要位于旧皮质,次级运动及感知觉中枢,局部皮质下白质等。AD患者大脑新皮质代谢及高级功能容易受损,而旧皮质及皮质下结构的代谢及功能出现代偿性增强,与BPSD相一致。

Objective： To study the cause and significance of regional cerebral metabolism rate of glucose （rCMRglc） in patients with Alzheimer disease （AD） Method： 33 AD patients, 17 patients with behavioral and psychological symptoms of dementia （BPSD） and 16 patients without BPSD, were recruited. All patients met AD diagnostic criteria of diagnostic and statistic manual of mental disorders ,4th ed （DSM-Ⅳ）. General information, mini mental state examination （MMSE）, ability of daily life （ADL）, Hachinski scale tests and positron emission tomography （PET） were performed in all AD patients and 20 matched healthy controls. The PET images were compared between the two groups with statistic parameter mapping pixel by pixel. Results：The rCMRglc of white matter under the medial gyrus of left frontal lobe, grey and white matter of left cuneus of occipital lobe （ Brodmann area 17）, the right tonsilla of cerebellum was higher in AD patients than the healthy controls （ P 〈 0. 001 ）. The rCMRglc of prefrontal lobe, occipito-parietal lobe and inferior temporal gyrus was broadly decreased in AD patients with BPSD （ P 〈 0. 001 ） , but the rCMRglc of the occipital lobe and cerebellum was increased （ P 〈 0. 001 ）. Conclusion ： Of all AD patients, with or without BPSD, the rCMRglc decreases diffusely in the brain,while the rCMRglc increasing in some regions, mainly in paleocortex, secondary motor center and sensory perception center, subeortieal white matter in some regions. The metabolism and high-ranking function of neocortex is impaired easily and the metabolism and function of paleocortex and subcortex increases compensationly.