不同分期肺腺癌患者大脑静息葡萄糖代谢改变研究

Preliminary study of metabolic changes in brain glucose of patients with lung adenocarcinoma

目的探讨无脑部转移的不同分期肺腺癌患者大脑静息葡萄糖代谢改变特点及其关系。方法回顾性分析120例组织学确诊为原发性肺腺癌患者的全身^18F—FDGPET／CT检查资料，其中I期患者为28例、Ⅱ期29例、Ⅲ期31例和Ⅳ期32例。50名健康体检者为对照组，分析I、Ⅱ、Ⅲ、Ⅳ期肺腺癌患者脑葡萄糖代谢改变，并比较4组之间脑代谢改变的差异。结果I、Ⅱ、Ⅲ、Ⅳ期肺腺癌患者PET脑显像均表现区域性脑代谢减低，I期累及脑区为左侧额上中回、右侧颞上中回、左侧颞中下回（体素数为681），Ⅱ期累及脑区为左侧额上中回、右侧颞上中回、左侧颞中下回（体素数为1258），Ⅲ期累及脑区为左侧额上中回、右侧颞上中回、左侧颞中下回、右侧顶下小叶（体素数为1810），Ⅳ期累及脑区为左侧额上中回、右侧颞上中下回、左侧颞上中下回、右侧顶下小叶、左侧前扣带回及右侧岛回（体素数为2910）。4组患者脑代谢减低区体素值差异具有统计学意义（斥25．444，P=0．0001），且随分期增加异常代谢脑区范围逐渐增大。结论肺腺癌患者脑代谢减低区涉及多个与精神情感有关的功能脑区，且其脑代谢改变与肿瘤分期具有一定相关陛。

Objective To investigate the metabolic changes in the resting brain glucose of patients with different stages of lung adenocarcinoma but without brain metastasis. Methods A total of 120 patients with primary untreated and histologically confirmed lung adenocarcinoma were divided into four groups based on TNM staging： stage I, 28 cases; stage Ⅱ, 29 cases; stage Ⅲ, 31 cases; and stage Ⅳ, 32 cases. The whole-body lSF-FDG PET/CT images of the patients were retrospectively analyzed. The brain PET data of the four groups were also examined individually and compared with those of the 50 healthy controls. Moreover, the metabolic changes in the brain glucose of the four groups were compared. Results The brain PET images showed relative reductions of the regional cerebral resting glucose metabolism of all the groups. In the stage I group, the reductions were mainly observed in the left superior-middle frontal, right superior-middle temporal, and left middle-inferior temporal gyrus. The total voxel value for this group was 681. The reductions in stage II group were evident in the left superior-middle frontal, right superior- middle temporal, and left middle-inferior temporal gyrus. The total voxel value for the stage II group was 1258. In the stage III group, reductions were evident in the left superior-middle frontal, right superior- middle temporal, left middle-inferior temporal gyrus, and right inferior parietal lobule. The total voxel value for the stage III group was 1810. In the stage IV group, reductions were evident in the left superior-middle frontal, right superior-middle-inferior temporal, left superior-middle-inferior temporal gyrus, right inferior parietal lobule, left anterior cingulated, and right insula gyms. The total voxel value for the stage IV group was 2910. The four groups showed significantly different voxel values in their hypometabolic brain area （F=25.444, P=0.000 1）, and the ranges expanded with tumor stage progression. Conclusions The reduced metabolic cerebral regions in lung adenocareinoma patients involved a number of functional regions related to mood disorders. The ranges of the metabolic changes in the resting brain glucose in lung adenocarcinoma patients were closely correlated to different tumor stages.