Vingerhoets F J, Snow B J, Lee C S, Schulzer M, Mak E, Calne D B
Neurodegenerative Disorders Centre, University Hospital, University of British Columbia, Vancouver, Canada.
Ann Neurol. 1994 Nov;36(5):759-64. doi: 10.1002/ana.410360512.
Previous estimates of the rate of progression of the nigral pathology underlying idiopathic parkinsonism (IP) have been derived mainly from pathological studies that have an inherent selection bias. Fluorodopa positron emission tomography (PET) is a reliable tool for assessing nigrostriatal dopaminergic function in vivo. We performed fluorodopa PET on two occasions, 7 years apart, on 16 patients with IP (age at the time of the first scan, 51 +/- 14 yr [mean +/- SD]) and 10 normal controls (age, 54 +/- 16 yr). For the patients with IP, the average duration of symptoms from the time of diagnosis to the first scan was 4.5 years (range, 1-12 yr); their PET index (striatal-occipital)/occipital ratio, dropped by 1.7% per year, from 0.49 +/- 0.08 to 0.43 +/- 0.08 (p < 0.001). The normals' ratio decreased by 0.3% per year from 0.77 +/- 0.05 to 0.75 +/- 0.10 (p = 0.33). The ratios in the IP group progressed significantly faster than the controls (p = 0.036). The rate of decline in IP represents 7.8% per decade, expressed as a fraction of the normals' initial mean value at 54 years of age. These results also permit power analysis for the design of future studies assessing the effect of treatment on the underlying pathology in IP.
以往对特发性帕金森病（IP）潜在黑质病理进展速率的估计主要来自存在固有选择偏倚的病理学研究。氟多巴正电子发射断层扫描（PET）是一种在体评估黑质纹状体多巴胺能功能的可靠工具。我们对16例IP患者（首次扫描时年龄为51±14岁[均值±标准差]）和10名正常对照者（年龄为54±16岁）进行了两次氟多巴PET检查，两次检查间隔7年。对于IP患者，从诊断到首次扫描的平均症状持续时间为4.5年（范围为1 - 12年）；他们的PET指数（纹状体 - 枕叶）/枕叶比值每年下降1.7%，从0.49±0.08降至0.43±0.08（p < 0.001）。正常对照者的比值每年下降0.3%，从0.77±0.05降至0.75±0.10（p = 0.33）。IP组的比值进展明显快于对照组（p = 0.036）。以54岁时正常对照者初始均值的分数表示，IP组的下降速率为每十年7.8%。这些结果也为未来评估治疗对IP潜在病理影响的研究设计提供了效能分析。
