混合型多系统萎缩病程与脑葡萄糖代谢相关性研究

Study of the brain glucose metabolism in different stage of mixed-type multiple system atrophy

目的探讨混合型多系统萎缩（MSA）病程与脑葡萄糖代谢之间的关系。方法46例符合Gilman诊断标准的混合型MSA患者，按病程分为3组：组1（14例），病程≤12个月；组2（13例），病程13～24个月；组3（19例），病程≥25个月。另选择年龄匹配的对照组18名（均为体格检查健康者）。所有纳入对象均行头部^18F—FDGPET／CT动态显像。应用SPM8软件将对照组分别与组1、2、3的^18F—FDGPET目标图像行两样本t检验，P〈0．005为差异有统计学意义。结果与对照组相比，在检验水平P〈0．005时，组1低代谢脑区（均t〉3．49）主要位于额叶、颞叶外侧、岛叶、前扣带回、尾状核及小脑前叶；组2低代谢脑区（均t〉3．21）除了上述部位以外，还出现在壳核后部及小脑后叶局部；组3低代谢脑区（均t〉4．08）扩大至双侧壳核及双侧小脑半球。另外，3组患者均存在稳定的高代谢脑区，主要位于顶叶、颞叶内侧及丘脑；组1、组2、组3对应t值范围分别为均f〉3．27、均￡〉3．02、均t〉3．30。结论混合型MSA的病程与脑葡萄糖代谢模式有关。额叶、颞叶外侧、前扣带回及尾状核在病变早期即可受累，随后壳核由后至前逐渐出现代谢减低，而丘脑一直保持高代谢状态。小脑代谢减低由前叶延伸至后叶。^18F—FDGPET／CT可较好反映混合型MSA病变的进展情况。

Objective To investigate the brain glucose metabolism in different stage of mixed-type multiple system atrophy （MSA）. Methods Forty-six MSA patients with cerebellar or Parkinsonian symptoms and 18 healthy controls with similar age as patients were included. According to the disease duration, the patients were divided into three groups： group 1 （ ~〈 12 months, n = 14） , group 2 （ 13-24 months, n= 13）, group 3 （ 〉125 months, n= 19）. All patients and controls underwent 18F-FDG PET/CT brain imaging. To compare metabolic distributions between different groups, SPM 8 software and two-sample t test were used for image data analysis. When P〈0.005, the result was considered statistically significant. Results At the level of P〈0.005, the hypometabolism in group 1 （ all t〉3.49） was identified in the frontal lobe, lateral temporal lobe, insula lobe, anterior cingulate cortex, caudate nucleus and anterior cerebellar hemisphere. The regions of hypometabolism extended to posterolateral putamen and part of posterior cerebellar hemisphere in group 2 （ all t〉3.21 ）. In group 3, the whole parts of putamen and cerebellar hemisphere were involved as hypometabolism （all t〉4.08）. In addition to the hypometabolism regions, there were also stabled hypermetabolism regions mainly in the parietal lobe, medial temporal lobe and the thalamus in all patient groups （ all t〉3.27 in group 1, all t〉3.02 in group 2, all t〉3. 30 in group 3）. Conclusions Disease duration is closely related to the FDG metabolism in the MSA patients. Frontal lobe, lateral temporal lobe, anterior cingulate cortex and eandate nucleus can be involved at early stage of the disease. Putaminal hypometabolism begins in its posterolateral part. Cerebellar hypometabolism occurs early at its anterior part. Besides, thalamus shows hypermetabolism in the whole duration, ^18F-FDG metabolic changes of brain can reflect the development of mixed-type MSA.