Tissingh G, Booij J, Bergmans P, Winogrodzka A, Janssen A G, van Royen E A, Stoof J C, Wolters E C
Graduate School for Neurosciences, Amsterdam, The Netherlands.
J Nucl Med. 1998 Jul;39(7):1143-8.
The aims of this study were to investigate whether the loss of striatal dopamine transporters in early and drug-naive patients with Parkinson's disease could be demonstrated by means of 123I-N-omega-fluoropropyl-2beta-carbomethoxy-3beta-(4-iodoph enyl)tropane (123I-FP-CIT) SPECT in a 1-day protocol and whether the SPECT measures were correlated with disease severity.
Twenty-one early-stage and drug-naive Parkinson's disease patients (age range 42-73 yr; mean age 55.5 yr) and 14 healthy controls (age range 28-83 yr; mean age 53.6 yr) were examined. SPECT image acquisition was always performed at 3 hr postinjection. The ratio of specific to nonspecific striatal 123I-FP-CIT binding was used as the outcome measure.
All striatal 123I-FP-CIT ratios were significantly lower in the Parkinson's disease group compared to those in the control group. The mean reduction in the putamen was 57% of the control mean, and that in the caudate nucleus was 29% of the control mean. Patients with unilateral Parkinson's disease showed a bilateral loss of striatal 123I-FP-CIT binding. Discriminant function analysis, using the 123I-FP-CIT SPECT data of the ipsilateral and contralateral putamen, predicted group membership in all cases; the contralateral putamen accounted for the greatest difference between the Parkinson's disease patients and the controls. In the control group, a clear decline in 123I-FP-CIT binding was found with aging, amounting to 9.6%/decade. Unexpectedly, in the Parkinson's disease group, regression analysis revealed that neither severity of disease nor age accounted for a significant part of the variance in striatal SPECT measures.
Our findings indicate that 123I-FP-CIT SPECT is a reliable method to discriminate between early, drug-naive Parkinson's disease patients and healthy controls and to identify patients in the preclinical phase of Parkinson's disease. Possibly due to the relatively homogeneous group of Parkinson's disease patients and the use of a suboptimal outcome measure, no significant correlations were found between striatal 123I-FP-CIT binding ratios and disease severity, such as were established earlier with 123I-beta-CIT. Further research is necessary to interpret these findings.
本研究的目的是调查在一日方案中，能否通过123I-N-ω-氟丙基-2β-甲氧基羰基-3β-(4-碘苯基)托烷（123I-FP-CIT）单光子发射计算机断层扫描（SPECT）来显示早期未用药的帕金森病患者纹状体多巴胺转运体的缺失，以及SPECT测量值是否与疾病严重程度相关。
对21例早期未用药的帕金森病患者（年龄范围42 - 73岁；平均年龄55.5岁）和14名健康对照者（年龄范围28 - 83岁；平均年龄53.6岁）进行检查。SPECT图像采集总是在注射后3小时进行。将纹状体特异性与非特异性123I-FP-CIT结合的比率用作结果指标。
与对照组相比，帕金森病组所有纹状体123I-FP-CIT比率均显著降低。壳核的平均降低幅度为对照组平均值的57%，尾状核的平均降低幅度为对照组平均值的29%。单侧帕金森病患者表现出双侧纹状体123I-FP-CIT结合缺失。使用同侧和对侧壳核的123I-FP-CIT SPECT数据进行判别函数分析，在所有病例中都能预测分组；对侧壳核在帕金森病患者和对照组之间的差异最大。在对照组中，发现123I-FP-CIT结合随年龄增长明显下降，下降幅度为每十年9.6%。出乎意料的是，在帕金森病组中，回归分析显示疾病严重程度和年龄均未占纹状体SPECT测量值变异的显著部分。
我们的研究结果表明，123I-FP-CIT SPECT是区分早期未用药的帕金森病患者和健康对照者以及识别帕金森病临床前期患者的可靠方法。可能由于帕金森病患者组相对同质且使用了次优的结果指标，纹状体123I-FP-CIT结合比率与疾病严重程度之间未发现显著相关性，而早期使用123I-β-CIT时已建立这种相关性。需要进一步研究来解释这些发现。
