成人缺血缺氧性脑病脑葡萄糖代谢减低的特点和分级

Characteristics and Classification of Cerebral Glucose Metabolic Decreases in Adults with Hypoxic-ischemic Encephalopathy

目的利用正电子发射断层扫描(PET)和统计参数图(SPM)研究成人缺血缺氧性脑病(HIE)脑葡萄糖代谢损伤特点,用以评价HIE脑代谢损伤程度。方法 26例HIE患者和20名健康对照者,均行18F标记的氟代脱氧葡萄糖(18F-FDG)脑PET显像。目视法分析观察脑内放射性减低区的位置、范围和减低程度;利用SPM对其PET影像进行分析,获得SPM三维投影图像和KE值。结果葡萄糖代谢减低以双侧性减低为主;双侧基底节和丘脑代谢减低最为明显;大脑皮质各叶出现代谢减低按易受损程度从高到低依次为额叶、枕叶、顶叶和颞叶;将基底节和丘脑作为评价代谢损伤程度的重要靶区,结合脑皮质损害情况,将缺血缺氧性脑病代谢损伤程度分为三级:Ⅰ级(轻度损伤)、Ⅱ级(中度损伤)和Ⅲ级(重度损伤)。结论基底节和丘脑是评价代谢损伤程度的重要靶区,结合脑皮质损伤程度和范围可对HIE的代谢损伤程度进行分级,用以指导临床治疗和预后评价。

Objective To study the characteristics of cerebral glucose metabolism in adults with hypoxic-ischemic encephalopathy （HIE） using positron emission tomography （PET） and statistical parameter mapping （SPM）, and evaluate the degree of the cerebral glucose metabolism damaged. Methods 26 HIE patients and 20 healthy controls received ＇SF-FDG PET imaging. The scope and degree of the brain radioactivity decrease were observed with visual analysis. The three-dimensional projection images and the KL value were obtained by SPM analysis. Results The glucose metabolic decrease in HIE was primarily bilaterally. The bilateral basal ganglia and thalamus metabolism de- creased most obviously. The brain cortical lobes varied degrees of metabolic decrease according to the order from high to low was the fron- tal, occipital, parietal and temporal lobes. The basal ganglia and thalamus were taken as the important target area of the evaluation of dam- age degree, the degree of damage of HIE was divided into Level Ⅰ （mild）, Level Ⅱ （moderate） and Level Ⅲ （severe） combined with cortex damage. Conclusion The basal ganglia and thalamus are the target areas of metabolic damage, the classification combined with brain cortex damage degree and scope can be used to guide the clinical treatment and prognosis evaluation.