早发型与晚发型帕金森病多巴胺能神经元和脑葡萄糖代谢变化差异

Differences of dopamine neurons and brain glucose metabolism between early-onset and late-onset Parkinson's disease

目的观察早发型帕金森病(EOPD)与晚发型帕金森病(LOPD)多巴胺神经元和脑葡萄糖代谢变化差异。方法前瞻性纳入45例EOPD患者(EOPD组)、55例LOPD患者(LOPD组)及93名健康对照(HC)者[HC1组(n=47),HC2组(n=46)],行^(11)C-β-CFT和18 F-FDG PET显像;观察EOPD组与HC1组、LOPD组与HC2组脑^(11)C-β-CFT标准摄取值比值(SUVR)和18 F-FDG葡萄糖代谢网络模式,以回归分析评估脑区^(11)C-β-CFT SUVR与18 F-FDG葡萄糖代谢的关系。结果EOPD组与HC1组之间,尾状核、壳核和苍白球^(11)C-β-CFT SUVR差异均有统计学意义(P均<0.05);LOPD组与HC2组之间,伏隔核、尾状核、壳核和苍白球^(11)C-β-CFT SUVR差异均有统计学意义(P均<0.05)。与HC1组相比,EOPD组双侧尾状核、壳核、苍白球、岛叶、小脑、颞叶、丘脑及额叶葡萄糖代谢明显增高(P均<0.05);相比HC2组,LOPD组双侧壳核、苍白球、中央旁回、小脑、颞叶及丘脑葡萄糖代谢明显增高(P均<0.05),双侧尾状核和额叶葡萄糖代谢明显减低(P均<0.05)。尾状核代谢为EOPD组伏隔核^(11)C-β-CFT SUVR减低的影响因素(P<0.001);尾状核、前额叶、小脑及丘脑代谢均为LOPD组伏隔核^(11)C-β-CFT SUVR减低的影响因素(P均<0.001)。结论LOPD患者伏隔核多巴胺神经元受损、尾状核和额叶葡萄糖代谢明显减低,而EOPD患者未见上述表现。

Objective To observe the differences of dopamine neurons and brain glucose metabolism between early-onset Parkinson's disease(EOPD)and late-onset Parkinson's disease(LOPD).Methods Forty-five EOPD patients(EOPD group),55 LOPD patients(LOPD group)and 93 healthy controls(HC)(HC1 group[n=47],HC2 group[n=46])were prospectively enrolled.^(11)C-β-CFT and 18 F-FDG PET imaging were performed.The standard uptake value ratio(SUVR)and 18 F-FDG glucose metabolic network pattern of brain were compared between EOPD group and HC1 group,also between LOPD group and HC2 group.Regression analysis was used to evaluate the relationships of ^(11)C-β-CFT SUVR and 18 F-FDG glucose metabolism of brain.Results Significant differences of ^(11)C-β-CFT SUVR in caudate nucleus,putamen and globus pallidus were found between EOPD group and HC1 group(all P<0.05),also among nucleus accumbens,caudate nucleus,putamen and globus pallidus between LOPD group and HC2 group(all P<0.05).Glucose metabolism in bilateral caudate nucleus,putamen,globus pallidus,insula,cerebellum,temporal lobe,thalamus and frontal lobe in EOPD group were significantly higher than those in HC1 group(all P<0.05).Glucose metabolism in bilateral putamen,globus pallidus,paracentral gyrus,cerebellum,temporal lobe and thalamus in LOPD group were significantly higher(all P<0.05),while in bilateral caudate nucleus and frontal lobe were significantly lower than those in HC2 group(both P<0.05).Glucose metabolism in caudate nucleus was the impact factor of decreased ^(11)C-β-CFT SUVR in nucleus accumbens of EOPD group(P<0.001),while glucose metabolism in caudate nucleus,prefrontal lobe,cerebellum and thalamus were all the impact factors of decreased ^(11)C-β-CFT SUVR in nucleus accumbens of LOPD group(all P<0.001).Conclusion Dopamine neurons in nucleus accumbens were damaged in LOPD patients with significantly decreased glucose metabolism in caudate nucleus and frontal lobe,which did not occur in EOPD patients.