帕金森病脑多巴胺转运体分布、葡萄糖代谢及临床症状评分的相关性

Correlations between striatal dopamine transporter distribution, glucose metabolism and clinical symptoms in Parkinson′s disease

目的探讨帕金森病(PD)患者脑内多巴胺转运体(DAT)分布、葡萄糖代谢及临床症状评分的相关性。方法收集2015年1月至2016年12月间行11C-2β-甲氧甲酰-3β-(4-氟苯基)托烷(CFT)及18F-脱氧葡萄糖(FDG)PET显像且经临床确诊的25例原发性PD患者[男17例、女8例,年龄(59.8±9.2)岁]资料,采用Pearson相关分析分别在整体和体素水平评价PD患者脑内DAT分布、葡萄糖代谢及临床指标之间的相关性。结果PD相关脑代谢网络模式(PDRP)值与统一PD评分量表(UPDRS)运动评分、非运动症状评分量表(NMSS)评分、日常生活能力评分量表(ADL)评分之间呈正相关(r=0.580、0.522、0.557,均P<0.05)。起病侧尾状核、前壳核、后壳核CFT摄取值与UPDRS运动评分呈负相关(r=-0.496、-0.492、-0.457,均P<0.05),与NMSS评分无相关性(r=-0.420、-0.402、-0.355,均P>0.05),起病侧尾状核、前壳核CFT摄取值与ADL评分呈负相关(r=-0.502、-0.522,均P<0.05);起病对侧尾状核、前壳核、后壳核CFT摄取值与PDRP值、UPDRS运动评分、NMSS评分、ADL评分无相关性(r=-0.466^-0.129,均P>0.05)。全脑CFT放射性计数与UPDRS运动评分、ADL评分主要在左侧壳核及尾状核呈负相关(r值:-0.90^-0.47,均P<0.05);全脑相对葡萄糖代谢与各临床症状评分间存在不同的相关性脑区;全脑相对葡萄糖代谢与CFT摄取值主要在双侧尾状核呈正相关(r值:0.47~0.90,均P<0.01),在双侧中央前回、壳核及岛叶呈负相关(r值:-0.90^-0.47,均P<0.01)。结论PD患者脑内多巴胺能功能障碍、葡萄糖代谢变化及临床表现之间存在复杂的相关关系,这可能有助于正确理解PET显像在PD中的作用,并为PD的发病机制研究提供更多证据。

Objective To investigate the correlations among striatal dopamine transporter (DAT) distribution, glucose metabolism and Parkinson′s disease (PD) clinical symptoms. Methods Twenty-five clinically confirmed idiopathic PD patients (17 males, 8 females, age:(59.8±9.2) years) who underwent 11C-2-beta-carbomethoxy-3-beta-(4-fluorophenyl)tropane (CFT) and 18F-fluorodeoxyglucose (FDG) PET imaging from January 2015 to December 2016 were reviewed. The detailed clinical scores were systematically collected from all patients. Correlations between DAT distribution, glucose metabolism and clinical symptoms were evaluated at global and voxel levels using Pearson correlation analysis. Results There were significantly positive correlations between the PD-related pattern (PDRP) value and unified PD rating scale (UPDRS) motor scores, non-motor symptoms scale (NMSS) scores, activity of daily living scale (ADL) scores (r values: 0.580, 0.522, 0.557, all P<0.05). The CFT uptake of ipsilateral caudate nucleus, anterior putamen, and posterior putamen were negatively correlated with UPDRS motor scores (r values:-0.496,-0.492,-0.457, all P<0.05), while those had no significant correlations with NMSS scores (r values:-0.420,-0.402,-0.355, all P>0.05). The CFT uptake of ipsilateral caudate nucleus and anterior putamen were negatively correlated with ADL scores (r values:-0.502,-0.522, both P<0.05). There were no significant correlations between CFT uptake in contralateral striatal, anterior putamen, posterior putamen and PDRP values, UPDRS motor scores, NMSS scores and ADL scores(r values: from -0.466 to -0.129, all P>0.05). The presence of the significant correlations between UPDRS motor scores, ADL scores and the CFT radioactive count were confirmed in left caudate nucleus and left putamen (r values: from -0.90 to -0.47, all P<0.05). The metabolic PET imaging disclosed a set of brain regions correlating with the clinical symptoms. The presence of significant correlations between the metabolic PET imaging and CFT uptake were confirmed in bilateral caudate nucleus (r values: 0.47-0.90, both P<0.01), precentral gyrus and insula (r values:-0.90 to -0.47, all P<0.01). Conclusion The correlations between DAT distribution, glucose metabolism and PD clinical symptoms are complicated, which promote the understanding in the proper application of dopaminergic and metabolic PET imaging in PD and offer more evidences in PD pathophysiological mechanisms.