Vadalà Maria, Cistaro Angelina, Quartuccio Natale, Calcagni Maria Lucia, Fania Piercarlo, Margotti Simone, Schiera Irene Giovanna, Laurino Carmen, Palmieri Beniamino
Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic.
Network of the Second Opinion, Modena.
Nucl Med Commun. 2020 Dec;41(12):1275-1282. doi: 10.1097/MNM.0000000000001280.
The aim of this study was to evaluate brain glucose metabolism by means of [18F]-fluoro-deoxygluycose (F-FDG) PET in a group of patients presenting dysautonomic syndrome after human papilloma virus (HPV) immunization.
Medical records of patients, referred to the 'Second Opinion Medical Consulting Network' Medical Centre (Modena, Italy) diagnosed with dysautonomic syndrome were searched. Inclusion criteria were presence in the medical history of adverse drug reactions following HPV vaccine; a Montreal Cognitive Assessment score <25 and good quality of a F-FDG-PET brain scan performed within 12 months from the diagnosis of dysautonomic syndrome. F-FDG-PET images of patients (HPV-group) were compared to a control group, matched for age and sex, using statistical parametric mapping (SPM).
The F-FDG-PET study was available for five female patients. The SPM-group analysis revealed significant hypometabolism (P < 0.05 false discovery rate corrected) in the right superior and medial temporal gyrus (Brodmann areas 22, 21) and insula (Brodmann area 13). At a threshold of P < 0.001 (uncorrected), further hypometabolic regions were revealed in the right superior temporal gyrus (Brodmann area 42) and caudate head and in the left superior temporal gyrus (Brodmann area 22), frontal subcallosal gyrus (Brodmann area 47) and insula (Brodmann area 13). Relative hypermetabolism (P = 0.001) was revealed in the right premotor cortex (Brodmann area 6).
This study revealed the possibility of altered brain glucose metabolism in subjects with dysautonomic syndrome post-immunization with HPV vaccine. These results could reinforce the hypothesis of a causal relationship between HPV vaccine, or some component included in the vaccine and the development of clinical manifestations.
本研究旨在通过[18F] - 氟脱氧葡萄糖（F-FDG）PET评估一组在人乳头瘤病毒（HPV）免疫后出现自主神经功能障碍综合征患者的脑葡萄糖代谢情况。
检索转诊至意大利摩德纳“第二意见医疗咨询网络”医疗中心且被诊断为自主神经功能障碍综合征患者的病历。纳入标准为HPV疫苗接种后有药物不良反应病史；蒙特利尔认知评估评分<25分，且在自主神经功能障碍综合征诊断后12个月内进行的F-FDG-PET脑扫描质量良好。使用统计参数映射（SPM）将患者（HPV组）的F-FDG-PET图像与年龄和性别匹配的对照组进行比较。
有5名女性患者的F-FDG-PET研究资料可用。SPM组分析显示，右侧颞上回和颞中回（布罗德曼区22、21）以及脑岛（布罗德曼区13）存在显著代谢减低（经错误发现率校正，P<0.05）。在P<0.001（未校正）的阈值下，右侧颞上回（布罗德曼区42）、尾状核头部以及左侧颞上回（布罗德曼区22）、额叶胼胝体下回（布罗德曼区47）和脑岛（布罗德曼区13）发现了更多代谢减低区域。右侧运动前皮质（布罗德曼区6）显示相对代谢增高（P = 0.001）。
本研究揭示了HPV疫苗免疫后出现自主神经功能障碍综合征患者脑葡萄糖代谢改变的可能性。这些结果可能强化HPV疫苗或疫苗中的某些成分与临床表现发展之间存在因果关系的假说。
