CAJ | 학술논문

目的应用99mTC-ECD SPECT/CT脑血流灌注显像半定量分析研究不同程度的广泛性焦虑障碍(GAD)患者脑血流变化特点.方法 2014年2-8月复旦大学附属华山医院心理咨询门诊和核医学科就诊的GAD-7评分＞4分的39例GAD患者(研究组)和10例对照者(对照组),均行99mTC-ECD SPECT/CT脑血流灌注显像检查,使用Scenium软件对全脑106个感兴趣区与双侧小脑像素比值进行半定量分析,比较不同焦虑程度GAD患者之间以及与对照组之间在不同脑区的血流灌注改变.结果 GAD患者在右侧额上回内侧、右侧楔前叶、右侧壳核、左、右侧中央旁小叶、左、右侧辅助运动皮质血流灌注减低(t=-2.19、-2.14、-2.22、-2.34、-2.08、-3.26、-2.72,均P＜0.05).11例轻度焦虑患者右侧嗅球血流灌注增加(=2.09,P=0.05),16例中度焦虑患者左、右侧额上回眶内、左侧辅助运动皮质血流灌注减低,而右侧嗅球血流灌注增加(t=-2.16、-2.24、-2.49、2.17,均P ＜0.05),11例重度焦虑患者左侧额叶、右侧壳核、左、右侧中央旁小叶、左、右侧楔前叶、左侧顶叶、左、右侧中央前回、右侧中央后回、左侧岛盖、左、右侧辅助运动皮质及左侧大脑皮质血流灌注减低(t=-2.32、-2.11、-3.16、-2.61、-2.39、-2.18、-2.32、-2.67、-2.14、-2.11、-2.25、-4.38、-3.54、-2.38,均P＜0.05).轻、中、重度焦虑患者在右侧额中回眶部(轻度0.96士0.07、中度1.03±0.06、重度0.98±0.08,P=0.04)、左侧中央旁小叶(轻度0.91±0.07、中度0.93士0.04、重度0.87±0.07,P=0.02)血流灌注差异有统计学意义,轻、中、重度焦虑患者在右侧中扣带回、左侧楔前叶、右侧楔前叶、左侧丘脑血流灌注呈负相关趋势(r=-0.28、-0.28、-0.27、-0.29,P=0.09、0.09、0.10、0.07).结论不同焦虑程度GAD患者皮质血流改变,GAD-7评分越高影响的脑区数目越多,Scenium软件对此可进行半定量评估,并为GAD疾病诊断提供可视化依据. 目的應用99mTC-ECD SPECT/CT腦血流灌註顯像半定量分析研究不同程度的廣汎性焦慮障礙(GAD)患者腦血流變化特點.方法 2014年2-8月複旦大學附屬華山醫院心理咨詢門診和覈醫學科就診的GAD-7評分＞4分的39例GAD患者(研究組)和10例對照者(對照組),均行99mTC-ECD SPECT/CT腦血流灌註顯像檢查,使用Scenium軟件對全腦106箇感興趣區與雙側小腦像素比值進行半定量分析,比較不同焦慮程度GAD患者之間以及與對照組之間在不同腦區的血流灌註改變.結果 GAD患者在右側額上迴內側、右側楔前葉、右側殼覈、左、右側中央徬小葉、左、右側輔助運動皮質血流灌註減低(t=-2.19、-2.14、-2.22、-2.34、-2.08、-3.26、-2.72,均P＜0.05).11例輕度焦慮患者右側嗅毬血流灌註增加(=2.09,P=0.05),16例中度焦慮患者左、右側額上迴眶內、左側輔助運動皮質血流灌註減低,而右側嗅毬血流灌註增加(t=-2.16、-2.24、-2.49、2.17,均P ＜0.05),11例重度焦慮患者左側額葉、右側殼覈、左、右側中央徬小葉、左、右側楔前葉、左側頂葉、左、右側中央前迴、右側中央後迴、左側島蓋、左、右側輔助運動皮質及左側大腦皮質血流灌註減低(t=-2.32、-2.11、-3.16、-2.61、-2.39、-2.18、-2.32、-2.67、-2.14、-2.11、-2.25、-4.38、-3.54、-2.38,均P＜0.05).輕、中、重度焦慮患者在右側額中迴眶部(輕度0.96士0.07、中度1.03±0.06、重度0.98±0.08,P=0.04)、左側中央徬小葉(輕度0.91±0.07、中度0.93士0.04、重度0.87±0.07,P=0.02)血流灌註差異有統計學意義,輕、中、重度焦慮患者在右側中釦帶迴、左側楔前葉、右側楔前葉、左側丘腦血流灌註呈負相關趨勢(r=-0.28、-0.28、-0.27、-0.29,P=0.09、0.09、0.10、0.07).結論不同焦慮程度GAD患者皮質血流改變,GAD-7評分越高影響的腦區數目越多,Scenium軟件對此可進行半定量評估,併為GAD疾病診斷提供可視化依據.
목적 응용99mTC-ECD SPECT/CT뇌혈류관주현상반정량분석연구불동정도적엄범성초필장애(GAD)환자뇌혈류변화특점.방법 2014년2-8월복단대학부속화산의원심리자순문진화핵의학과취진적GAD-7평분＞4분적39례GAD환자(연구조)화10례대조자(대조조),균행99mTC-ECD SPECT/CT뇌혈류관주현상검사,사용Scenium연건대전뇌106개감흥취구여쌍측소뇌상소비치진행반정량분석,비교불동초필정도GAD환자지간이급여대조조지간재불동뇌구적혈류관주개변.결과 GAD환자재우측액상회내측、우측설전협、우측각핵、좌、우측중앙방소협、좌、우측보조운동피질혈류관주감저(t=-2.19、-2.14、-2.22、-2.34、-2.08、-3.26、-2.72,균P＜0.05).11례경도초필환자우측후구혈류관주증가(=2.09,P=0.05),16례중도초필환자좌、우측액상회광내、좌측보조운동피질혈류관주감저,이우측후구혈류관주증가(t=-2.16、-2.24、-2.49、2.17,균P ＜0.05),11례중도초필환자좌측액협、우측각핵、좌、우측중앙방소협、좌、우측설전협、좌측정협、좌、우측중앙전회、우측중앙후회、좌측도개、좌、우측보조운동피질급좌측대뇌피질혈류관주감저(t=-2.32、-2.11、-3.16、-2.61、-2.39、-2.18、-2.32、-2.67、-2.14、-2.11、-2.25、-4.38、-3.54、-2.38,균P＜0.05).경、중、중도초필환자재우측액중회광부(경도0.96사0.07、중도1.03±0.06、중도0.98±0.08,P=0.04)、좌측중앙방소협(경도0.91±0.07、중도0.93사0.04、중도0.87±0.07,P=0.02)혈류관주차이유통계학의의,경、중、중도초필환자재우측중구대회、좌측설전협、우측설전협、좌측구뇌혈류관주정부상관추세(r=-0.28、-0.28、-0.27、-0.29,P=0.09、0.09、0.10、0.07).결론 불동초필정도GAD환자피질혈류개변,GAD-7평분월고영향적뇌구수목월다,Scenium연건대차가진행반정량평고,병위GAD질병진단제공가시화의거.
Objective To assess the perfusion changes in brains of patients with varying levels of generalized anxiety disorder (GAD).Methods A total of 38 GAD outpatients of Department of Psychiatry at our hospital from February to August,2014 and 10 healthy controls received a 99mTc-ECD SPECT/CT scan with scenium analysis.Differences between brain perfusion and anxiety levels were analyzed by SPSS 16.0 with one-way ANOVA,Pearson's Chi-square,t test and Spearman's correlation.Results They were grouped according to the levels of anxiety severity,i.e.mild (n =11),moderate (n =16) and severe (n =11).They had significantly lower blood flow in right superior frontal medial gyrus,right precuneus,right putamen,bilateral paracentral lobule and bilateral supplementary motor area (t =-2.19,-2.14,-2.22,-2.34,-2.08,-3.26,-2.72,P ＜ 0.05).Individuals had significantly greater blood flow in mild group than those of control group in right olfactory (t =2.09,P =0.05).Individuals of moderate group had significantly lower blood flow than those of control group in left superior frontal gyrus medial orbital,right superior frontal gyrus medial orbital and left supplementary motor area,but greater in right olfactory (t =-2.16,-2.24,-2.49,2.17,P =0.04,0.04,0.02,0.04).Individuals had lower blood flow in severe group than those of control group in left frontal lobe,right putamen,left paracentral lobule,right paracentral lobule,left precuneus,right precuneus,left parietal lobe,left precentral,right precentral,right postcentral,left rolandic operculum,left supplementary motor area,right supplementary motor area and left central region (t=-2.32,-2.11,-3.16,-2.61,-2.39,-2.18,-2.32,-2.67,-2.14,-2.11,-2.25,-4.38,-3.54,-2.38,P=0.03,0.05,0.01,0.02,0.03,0.04,0.03,0.02,0.05,0.05,0.04,0.00,0.00,0.03).Statistical differences existed in right middle frontal gyrus orbital part (mild:0.96 ± 0.07,moderate:1.03 ± 0.06,severe:0.98 ± 0.08,P =0.04) and left paracentral (mild:0.91 ±0.07,moderate:0.93 ±0.04,severe:0.87 ±0.07,P =0.02).There was a tendency of negative correlation between perfusion in right middle cingulate and paracingulate gyri,left precuneus,right precuneus and left thalamus and anxiety scores by Spearman's correlation analysis (r =-0.28,-0.28,-0.27,-0.29,P =0.09,0.09,0.10,0.07).Conclusion Scenium software provides quantitative measurements for diagnosis of GAD in different anxiety levels.Also larger samples are required for confirming the results in further studies.