神经性厌食99mTc-ECD局部脑血流变化初探

神经性厌食(Anorexia Nervosa,AN)是一种病因未明的心理行为综合症,社会文化及生物学因素间的交互作用被认为是该病的病因,脑成像体现出一些病理相关改变,但国内尚未见针对此病的成像报道。为给临床辅助诊断AN提供依据,采用经济、易获得的脑功能显像技术——单光子发射计算机断层显像(Single Photon Emission Computed Tomography,SPECT),扫描3位典型青年女性AN患者的大脑。通过统计参数图(Statistical Parametric Mapping,SPM2),基于体素的局部脑血流灌注分析,与25名正常青年女性脑图相比较发现,患者的前扣带和前额内侧、双侧额叶背外侧、后顶叶、颞叶中上部和小脑血流灌注降低,下丘脑、双侧颞叶中下部血流灌注增高,可能与神经递质回路有关,提示社会学因素可能只是该病的诱因,而生物学人格易感性才是该病的主要原因,同时说明SPECT脑血流成像有助于AN的临床辅助诊断。

Exploring the Regional Cerebral Blood Flow in a patient with Anorexia Nervosa using 99mTc-ECD Single Photon Emission Computed Tomography

Anorexia nervosa (AN) is a disorder characterized by deliberate weight loss with abnormal eating behaviors. It is known that the interaction of social-cultural and biological factors are the etiology of this disease, and some evidence of abnormal changes in the patients' brain imaging was found. In order to probe into how this disease develops and helps to make a diagnosis with clinical auxiliaries, single photon emission computed tomography (SPECT) was administered to attain the regional brain blood flow maps of 3 typical anorexia nervosa patients accompanied by severe depressive attack. The maps were statistically compared with 25 healthy controls' using Statistical Parametric Mapping (SPM2) in the voxel base. Hypoperfusion has been shown in the anterior cingulate cortex (ACC) with the medial prefrontal cortex (MPFC), the dorsolateral prefrontal cortex (DLPFC), the posterior parietal cortex (PPC), the superior and middle parts of temporal lobes and the cerebellum bilaterally relative to the control. It has also been found hyperperfusion in the hypothalamus as well as the bilateral inferior and middle parts of temporal lobes relative to the control. These abnormalities are acknowledged to be associated with the disturbance of neural circuits correlative with 5-HT and DA neurotransmission systems and persistent in a long term even after recovery from AN, which indicates that AN is a trait disease and the social-cultural factor may only be the inducer. The technique of brain mapping may facilitate to diagnose and evaluate the treatment.