难治性强迫症的脑内^18F—FDG摄取变化及其异常脑功能环路研究

l8F-FDG uptake changes in the brain functional loop in patients with refractory obsessive compulsivedisorder

目的应用”F—FDGPET显像研究难治性强迫症脑内葡萄糖异常代谢区域，为临床诊疗提供客观的影像学依据。方法对8例难治性强迫症患者和8名健康对照者进行脑”F．FDGPET显像，利用SPM软件进行对比，分析强迫症患者葡萄糖代谢改变的脑区，并对代谢变化与Yale—Brown强迫症评定量表（Y—BOCS）评分进行相关性研究。结果难治性强迫症患者双侧额叶皮质（包括直回、眶回及扣带回）、左侧丘脑、右侧颞叶、双侧小脑葡萄糖代谢高于健康对照组（Zmax=3．45～5．80，P均〈0．001）；而双侧额叶运动区皮质及双侧顶叶（BA7）呈低代谢（Zmax=3．44～4．46，P均〈0．001）。Y—BOCS评分与双侧前扣带回皮质葡萄糖代谢呈正相关（zmax=3．77，3．48，2．97，P均〈0．01）。结论难治性强迫症患者脑内额叶一纹状体一丘脑一额叶环路葡萄糖代谢增高，同时伴随双侧额叶运动区皮质及顶叶葡萄糖代谢减低；前扣带回葡萄糖代谢状态有助于评价强迫症病情的严重程度。

Objective To investigate the glucose metabolic pattern of brain functional loop in pa- tients with refractory obsessive compulsive disorder （OCD） using 18F-FDG PET. Methods Eight patients with refractory OCD and 8 age- and gender-matched healthy volunteers underwent is F-FDG PET brain ima- ging. SPM software was used for image post-processing and quantitative analysis. Correlation analysis be- tween 18F-FDG uptake and Yale-Brown obsessive compulsive scale（Y-BOCS） score was performed. Results Compared with the controls, the glucose metabolism of bilateral frontal cortices （ including the rectal gyrus, orbital gyrus and cingnlate gyrns）, left thalamus, fight temporal lobe and bilateral cerebellum in refractory OCD patients increased significantly （ Z,~ = 3.45 - 5.80, all P 〈 0.001 ）. Bilateral motor cortices and bi- lateral parietal lobes （ BA7 ）, however, showed decreased glucose metabolism （ Zmax = 3.44 -- 4.46, all P 〈 0.001 ）. Y-BOCS score was positively correlated with the glucose metabolism of the bilateral anterior cingu- late cortex （ Zmax= 3.77, 3.48 and 2.97, all P 〈 0.01 ）. Conclusions There is a characteristic metabolic pattern of increased glucose utilization in the fronto-striato-thalamic loop and decreased glucose utilization in bilateral motor cortices and parietal lobes in patients with OCD. The glucose metabolism in the anterior cin- gulate cortex might serve as a quantitative parameter for the assessment of the severity of OCD.