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肺癌是临床最常见的恶性肿瘤,患者发病后常伴发多种精神情感障碍症状,如恐惧、焦虑、抑郁等[1]。应用PET研究恶性肿瘤患者脑代谢的改变规律有助于揭示恶性肿瘤患者精神异常的发生特点和产生机制。早期的部分研究已显示,恶性肿瘤患者存在广泛的脑代谢异常[2],少数分类研究也已显示了不同类型肿瘤患者脑代谢改变的差异性[3-4],但对肺部恶性肿瘤脑代谢改变特点尤其是组织学分型相关性研究国内外尚未见报道。本研究通过对100例原发性肺癌患者大脑静息18F-FDG PET代谢显像资料的回顾性分析,初步探讨肺癌患者脑代谢改变特点及其与组织学类型的关系,揭示肺癌患者精神情感障碍的产生基础,并为临床诊治提供客观的分子学依据和可能的评价指标。
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腺癌组、鳞癌组和小细胞肺癌组患者脑18F-FDG PET图像与对照组比较,静息状态下肺癌患者脑葡萄糖代谢改变均以降低为主。腺癌患者脑代谢降低区域共计1436个体素数,主要涉及双侧颞叶和左侧额叶,详细分布区见表 1和图 1;鳞癌患者脑代谢降低区域共计1397个体素数,详细分布区见表 2和图 2;小细胞肺癌患者脑代谢降低区域共计3848个体素数,除额颞叶外还可见右侧顶下小叶及右侧海马区周围代谢降低,详细分布区见表 3和图 3。统计学对比显示,小细胞肺癌组低代谢脑区面积(体素数3848)分别大于腺癌组(体素数1436)(t=14.33,P < 0.05)和鳞癌组(体素数1397)(t=10.07,P < 0.05),腺癌组和鳞癌组低代谢脑区体素数差异无统计学意义(t=0.764,P>0.05)。
脑功能区 Brodmann区 Talairach坐标 体素数 t值 P值 X Y Z 左侧颞中下回 20,21 -52 -31 -18 391 5.23 < 0.05 右侧颞上中回 21,22,42 58 -46 -16 532 6.41 < 0.05 左侧额上中回 6,8,9 -42 28 38 513 6.41 < 0.05 注:表中,Brodmann区表示相应的激活区在全脑的Brodmann分区上所处的区域。 表 1 腺癌组患者相对于正常对照组脑内代谢减低的区域分布
Table 1. Positions of the reduced glucose metabolism cerebral regions in patients with adenocarcinoma
脑功能区 Brodmann区 Talairach坐标 体素数 t值 P值 X Y Z 左侧颞中下回 20,21 -46 -26 -8 406 5.62 < 0.05 右侧颞上中回 21,22,42 39 -42 -126 482 6.33 < 0.05 左侧额上中回 6,8,9 -48 32 22 509 6.85 < 0.05 注:表中,Brodmann区表示相应的激活区在全脑的Brodmann分区上所处的区域。 表 2 鳞癌组患者相对于正常对照组脑内代谢减低的区域分布
Table 2. Positions of the reduced glucose metabolism cerebral regions in patients with squamous cell carcinoma
脑功能区 Brodmann区 Talairach坐标 体素数 t值 P值 X Y Z 左侧颞上、中、下回 20,21,22 -46 -32 -8 1014 5.52 < 0.05 右侧颞上中回、顶下小叶 21,22,39 48 -20 -12 1324 5.34 < 0.05 左侧额上中回 6,8,9 -42 30 36 1257 5.88 < 0.05 海马、尾状核(右) 30 37 -20 -15 253 6.75 < 0.05 注:表中,Brodmann区表示相应的激活区在全脑的Brodmann分区上所处的区域。 表 3 小细胞肺癌组患者相对于正常对照组脑内代谢减低的区域分布
Table 3. Positions of the reduced glucose metabolism cerebral regions in patients with small-cell lung carcinoma
图 1 腺癌组患者相对于正常对照组脑内代谢减低区图(红色区域)
Figure 1. Compared with the control group, the cerebral regions of reduced brain glucose metabolism(red areas) in the patient with lung adenocarcinoma
不同组织学类型肺癌患者大脑静息葡萄糖代谢改变研究
The preliminary study of brain glucose metabolism changes in patients with lung cancer of different histological types
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摘要:
目的 探讨不同组织学类型肺癌患者大脑静息葡萄糖代谢改变特点。 方法 回顾性分析100例未经治疗的原发性肺癌患者全身18F-FDG PET/CT检查资料。肺癌组织学类型均经穿刺或手术病理明确,根据不同组织学类型将患者分为腺癌(42例)、鳞癌(37例)、小细胞肺癌(21例)3组。将50名健康体检者作为对照,采用统计参数地形图分析软件分析每组患者PET脑代谢显像资料,采用两样本t检验比较3组患者脑代谢改变的差异。 结果 3组患者脑PET显像均表现为区域性大脑静息葡萄糖代谢降低,主要分布在左侧额叶上中回及双侧颞叶上、中、下回,小细胞肺癌组还可见右侧顶下小叶及海马区受累。小细胞肺癌组低代谢脑区面积(体素数3848)大于腺癌组(体素数1436)(t=14.33,P < 0.05)和鳞癌组(体素数1397)(t=10.07,P < 0.05),腺癌组与鳞癌组之间差异无统计学意义(t=0.764,P>0.05)。 结论 肺癌患者大脑静息葡萄糖代谢改变与其组织学类型有一定相关性。脑代谢降低区多涉及精神情感功能区,PET脑显像有望为肺癌患者出现的精神情感障碍症状提供客观的分子影像学依据和可能的评价指标。 -
关键词:
- 肺肿瘤 /
- 脑葡萄糖代谢 /
- 正电子发射断层显像术 /
- 体层摄影术,X线计算机 /
- 氟脱氧葡萄糖F18
Abstract:Objective To investigate the changes of resting brain glucose metabolism in patients with lung cancer of different histological types. Methods One hundred patients with primary untreated lung cancer were divided into three groups[adenocarcinoma group(42 cases), squamous cell carcinoma group(37 cases)and small-cell carcinoma group(21 cases)] based on histological types confirmed by biopsy or surgical pathology. Their whole body 18F-FDG PET/CT were retrospectively studied. The brain PET data of three groups were analyzed individually using statistical parametric mapping, with 50 healthy controls as comparison. Results The brain PET imaging in all of three lung cancer groups showed relative reduction in the regional cerebral resting glucose metabolism, and mainly distributed in left superior and middle frontal gyrus and the inferior, middle and superior frontal gyrus bilateral frontal lobe. Besides, the hypometabolic brain areas were also detected in the right inferior parietal lobule and hippocampal in the small cell carcinoma group. The total hypometabolic brain area in the small cell lung cancer group(voxel values 3848)was greater than those in the adenocarcinoma(voxel values 1436)(t=14.33, P < 0.05)and the squamous cell carcinoma groups(voxel values 1397)(t=10.07, P < 0.05) respectively, and there was no statistical difference with respect to the areas between the later two groups(t=0.764, P>0.05). Conclusions The resting brain glucose metabolic changes in lung cancer patients may be correlated to their histological types of lung cancer. The reduced metabolic regions in lung cancer patients involved in some functional regions related to the mood disorders. The brain metabolic changes hopefully provide molecular imaging basis and evaluation indicator for lung cancer patients with affective disorders. -
表 1 腺癌组患者相对于正常对照组脑内代谢减低的区域分布
Table 1. Positions of the reduced glucose metabolism cerebral regions in patients with adenocarcinoma
脑功能区 Brodmann区 Talairach坐标 体素数 t值 P值 X Y Z 左侧颞中下回 20,21 -52 -31 -18 391 5.23 < 0.05 右侧颞上中回 21,22,42 58 -46 -16 532 6.41 < 0.05 左侧额上中回 6,8,9 -42 28 38 513 6.41 < 0.05 注:表中,Brodmann区表示相应的激活区在全脑的Brodmann分区上所处的区域。 表 2 鳞癌组患者相对于正常对照组脑内代谢减低的区域分布
Table 2. Positions of the reduced glucose metabolism cerebral regions in patients with squamous cell carcinoma
脑功能区 Brodmann区 Talairach坐标 体素数 t值 P值 X Y Z 左侧颞中下回 20,21 -46 -26 -8 406 5.62 < 0.05 右侧颞上中回 21,22,42 39 -42 -126 482 6.33 < 0.05 左侧额上中回 6,8,9 -48 32 22 509 6.85 < 0.05 注:表中,Brodmann区表示相应的激活区在全脑的Brodmann分区上所处的区域。 表 3 小细胞肺癌组患者相对于正常对照组脑内代谢减低的区域分布
Table 3. Positions of the reduced glucose metabolism cerebral regions in patients with small-cell lung carcinoma
脑功能区 Brodmann区 Talairach坐标 体素数 t值 P值 X Y Z 左侧颞上、中、下回 20,21,22 -46 -32 -8 1014 5.52 < 0.05 右侧颞上中回、顶下小叶 21,22,39 48 -20 -12 1324 5.34 < 0.05 左侧额上中回 6,8,9 -42 30 36 1257 5.88 < 0.05 海马、尾状核(右) 30 37 -20 -15 253 6.75 < 0.05 注:表中,Brodmann区表示相应的激活区在全脑的Brodmann分区上所处的区域。 -
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