Rudolf J, Sobesky J, Ghaemi M, Heiss W-D
Klinik für Neurologie der Universität zu Köln, and Max-Planck-Institut für Neurologische Forschung, Köln, Germany.
Eur J Neurol. 2002 Nov;9(6):671-7. doi: 10.1046/j.1468-1331.2002.00468.x.
This paper compares the results of parallel positron emission tomography (PET) studies of regional cerebral glucose metabolism with the radiotracer 18F-fluorodeoxyglucose (FDG) and benzodiazepine receptor (BZR) density by PET using the BZR ligand 11C-flumazenil (FMZ), a tracer of neuronal integrity, in nine patients with acute vegetative state (AVS, duration <1 month). Overall glucose utilization was significantly reduced in AVS in comparison with age-matched controls (global metabolic rate for glucose 26 micromol/100 g/min in AVS vs. 31 micromol/100 g/min in controls). FMZ-PET demonstrated a considerable reduction of BZR binding sites in all cortical regions that grossly corresponded to the extent of reduction of cerebral glucose metabolism assessed with FDG-PET, whilst the cerebellum was spared from neuronal loss. In controls, cortical relative flumazenil binding was not lower than five times the average white matter activity, whilst in AVS, nearly all values were below this threshold. There was no relevant overlap of the data of relative flumazenil binding between both groups. The comparison of FDG- and FMZ-PET findings in AVS demonstrates that alterations of cerebral glucose consumption do not represent mere functional inactivation, but irreversible structural brain damage.
本文比较了9例急性植物状态（AVS，病程<1个月）患者使用放射性示踪剂18F-氟脱氧葡萄糖（FDG）进行的局部脑葡萄糖代谢的正电子发射断层扫描（PET）平行研究结果，以及使用BZR配体11C-氟马西尼（FMZ，一种神经元完整性示踪剂）通过PET测定的苯二氮䓬受体（BZR）密度。与年龄匹配的对照组相比，AVS患者的整体葡萄糖利用率显著降低（AVS患者的全脑葡萄糖代谢率为2μmol/100g/min，而对照组为31μmol/100g/min）。FMZ-PET显示所有皮质区域的BZR结合位点显著减少，这与FDG-PET评估的脑葡萄糖代谢减少程度大致相符，而小脑未出现神经元丢失。在对照组中，皮质相对氟马西尼结合不低于平均白质活性的5倍，而在AVS患者中，几乎所有值均低于该阈值。两组之间相对氟马西尼结合数据没有相关重叠。AVS患者FDG-PET和FMZ-PET结果的比较表明，脑葡萄糖消耗的改变并非仅仅是功能失活，而是不可逆的脑结构损伤。
