高血压对阿尔茨海默病患者脑18F-脱氧葡萄糖代谢、淀粉样蛋白沉积与认知功能影响及相关性研究

Effect of hypertension on brain 18F-fluorodeoxyglucose metabolism,amyloid deposition and cognitive function in Alzheimer’s disease

目的探讨高血压对阿尔茨海默病(AD)患者18F-脱氧葡萄糖(FDG)代谢、淀粉样蛋白沉积与认知功能影响之间的相关性。方法选取自2014年1月至2018年6月北部战区总医院神经内科收治的58例AD患者为研究对象。根据血压分类标准将其分为A组(合并高血压,n=30)与B组(不合并高血压,n=28)。两组患者均采用阿尔茨海默病评价量表-认知分量表(ADAS-Cog)、神经精神科问卷知情者版(NPI-Q)、韦氏记忆量表(WMS-RC)进行认知功能评估。采用11C-PIB与18F-FDG PET/CT脑显像评估β-淀粉样蛋白(Aβ)沉积及葡萄糖代谢情况。分析患者血浆中Aβ40、Aβ42、t-tau、皮质醇及舒张压水平与11C-PIB标准化摄取值比(SUVR)之间的相关性。结果 B组患者的ADAS-Cog、NPI-Q、WMS-RC评分均优于A组,差异有统计学意义(P <0. 05)。A组患者的海马区SUVR值低于B组,全脑11C-PIB的SUVR值高于B组患者,差异有统计学意义(P <0. 05)。A组患者的血清皮质醇水平高于B组,差异有统计学意义(P <0. 05)。AD患者舒张压与11C-PIB SUVR呈正相关(r=0. 417,P <0. 05);血清皮质醇水平与11C-PIB SUVR呈正相关(r=0. 318,P <0. 05)。结论高血压与认知功能减退、海马低代谢、Aβ沉积增加有关,有效控制血压可能对AD治疗具有潜在价值。

Objective To investigate the relationship between hypertension and 18F-fluorodeoxyglucos(18F-FDG) metabolism,amyloid deposition and cognitive function in patients with Alzheimer’s disease( AD). Methods A retrospective study was performed on 58 cases of patients with AD who were admitted from January 2014 to June 2018. According to the blood pressure classification criteria,patients were divided into the Group A( with hypertension,n = 30) and Group B( without hypertension,n = 28). The cognitive function of the two groups was assessed by Alzheimer’ s disease assessment scale-cognitive subscale( ADAS-cog),neuropsychiatry information questionnaire( NPI-Q) and Wechsler memory scale( WMS-RC).11C-PIB and18F-FDG PET/CT brain imaging were used to assess the deposition of Aβ and glucose metabolism. The correlation between plasma,11C-PIB standardized uptake ratio( SUVR) and levels of Aβ40,Aβ42,t-tau and cortisol were analyzed. Results The ADAS-Cog,NPI-Q and WMS-RC scores in Group B were all better than those in Group A,with statistically significant differences( P < 0. 05). SUVR value of hippocampus in Group A was lower than that in Group B,and the total brain SUVR value of11C-PIB was higher than that in Group B( P < 0. 05). The serum cortisol level in Group A was higher than that in Group B( P < 0. 05). Diastolic blood pressure in AD patients was positively correlated with11C-PIB SUVR( r =0. 417,P < 0. 05). Serum cortisol level was positively correlated with11C-PIB SUVR( r = 0. 318,P < 0. 05). Conclusion Hypertension is associated with cognitive decline,low hippocampal metabolism,and increased Aβ deposition,effective blood pressure control may have potential value for AD therapy.