利用^(18)F标记脱氧葡萄糖正电子发射断层评价肢体缺血预适应的疗效

Effect of Limb Ischemic Preconditioning Evaluated with ^(18)F Labeled Deoxyglucose Positron Emission Tomography

目的利用正电子发射断层扫描(PET)和统计参数图(SPM)观察肢体缺血预适应治疗对缺血性脑卒中患者脑葡萄糖代谢的影响。方法选择本院门诊缺血性脑卒中患者40例,经颅多普勒超声(TCD)检查证实患单侧颅内动脉中、重度狭窄或闭塞,磁共振成像(MRI)检查除外颅内占位性病变和出血性病变。根据随机数字表随机纳入肢体缺血预适应组(20例)和对照组(20例)。通过比值法和SPM法分别对两组患者治疗前后的脑葡萄糖代谢显像结果进行对比分析。结果对照组脱落5例。比值分析法:好转情况方面肢体缺血预适应组明显优于对照组(P<0.01),进展情况方面对照组更重(P<0.05)。SPM分析法:①设治疗后代谢增加,肢体缺血预适应组得到9个具有统计学意义的代谢激活区,包括额叶、顶叶、颞叶、枕叶、基底节和丘脑,总KE值=927;对照组得到3个具有统计学意义的代谢激活区,包括额叶、顶叶和枕叶,总KE值=289。②设治疗后代谢减低,肢体缺血预适应组得到0个具有统计学意义的代谢激活区;对照组得到2个具有统计学意义的代谢激活区,包括顶叶和颞叶,总KE值=115。结论 PET脑葡萄糖代谢显像可观察到经肢体缺血预适应治疗后缺血性脑卒中患者皮质、基底节和丘脑等处葡萄糖代谢的改善情况,从而为临床判断疗效提供客观的影像学依据。

Objective To evaluate the therapeutic effect of limb ischemic preconditioning （LIPC） by observing the changes of brain glu- cose metabolism using positron emission tomography （PET） and statistical parametric mapping （SPM）. Methods 40 patients with severe ste- notic or occlusion cerebral artery lesions were enrolled and randomized into LIPC group （n=20） and control group （n=20）. Brain lesions and cerebral hemorrhagic lesions were excluded after magnetic resonance imaging. The glucose metabolism of patients was analyzed before and after treatment in two groups, respectively, using the methods of radioactivity ratio and SPM. Results There were 5 patients drop-out in the control group. Comparison of the glucose metabolism ratio of the impaired area to the opposite area： LIPC group improved better than the control group （P〈0.01） while the control group aggravated heavier than LIPC group （P〈0.05）. Comparing the glucose metabolism of pa- tients before and after treatment in two groups, respectively, by paired-t test, 1） Setting the glucose metabolism of patients increased after therapy： There were 9 areas activated in LIPC group, including frontal, parietal, temporal, occipital lobes, basal ganglia and thalamus, and the K~=927, while there were only 3 areas activated in the control group, including frontal, parietal and occipital lobes, and the K~=289.2） Setting the glucose metabolism of patients decreased after therapy： There was no area activated in LIPC group, while there were 2 areas acti- vated in the control group, including parietal and temporal lobes, and the K~=I 15. Conclusion The improvement of glucose metabolism was observed in cerebral cortex, basal ganglia and thalamus of the patients with severe stenotic or occlusion cerebral artery lesions after LIPC by PET and SPM.