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恶性肿瘤患者易伴发抑郁为临床共识,不同的肿瘤或同一肿瘤的不同阶段产生精神情感障碍的表现和程度亦常有不同。以往的PET脑显像显示,恶性肿瘤患者存在多个精神情感功能区的脑代谢异常,但对肿瘤患者进行细致的分型或分期来探讨其脑代谢异常发展规律的报道尚少。付畅等[1]对不同组织学类型肺癌的脑代谢改变做过初步研究,发现肺癌患者脑葡萄糖代谢改变与其组织学类型具有相关性。本研究在此基础上继续搜集病例,在限定组织学分型(肺腺癌)的基础上探讨肿瘤分期与脑葡萄糖代谢改变的关系。
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Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期组肺腺癌患者脑PET图像与对照组比较,均显示有静息状态下的区域性脑代谢减低(图 1~4)。
图 1 肺腺癌Ⅰ期组大脑静息葡萄糖代谢减低区(红色区域)
Figure 1. The cerebral regions of reduced brain glucose metabolism(red areas)in the Ⅰstage group patients with lung adenocarcinoma
图 2 肺腺癌Ⅱ期组大脑静息葡萄糖代谢减低区(红色区域)
Figure 2. The cerebral regions of reduced brain glucose metabolism(red areas) in the Ⅱstage group patients with lung adenocarcinoma
图 3 肺腺癌Ⅲ期组大脑静息葡萄糖代谢减低区(红色区域)
Figure 3. The cerebral regions of reduced brain glucose metabolism(red areas)in the Ⅲ stage group patients with lung adenocarcinoma
图 4 肺腺癌Ⅳ期组大脑静息葡萄糖代谢减低区(红色区域)
Figure 4. The cerebral regions of reduced brain glucose metabolism(red areas)in the Ⅳ stage group patients with lung adenocarcinoma
Ⅰ期组患者脑代谢减低见于左侧额上中回、右侧颞上中回、左侧颞中下回(图 1),脑代谢减低区域共计681个体素数,具体分布区见表 1。
脑区 Tal坐标 素数 t值 P值 X Y Z 左侧额上中回 -12 59 12 218 5.34 < 0.05 右侧颞上中回 54 -62 4 276 5.21 < 0.05 左侧颞中下回 -47 -23 -21 187 6.27 < 0.05 表 1 肺腺癌Ⅰ期组大脑静息葡萄糖代谢减低区
Table 1. Positions of the reduced glucose metabolism cerebral regions in the Ⅰstage group patients with lung adenocarcinoma
Ⅱ期组患者脑代谢减低见于左侧额上中回、右侧颞上中回、左侧颞中下回(图 2),脑代谢减低区域共计1258个体素数,具体分布区见表 2。
脑区 Tal坐标 素数 t值 P值 X Y Z 左侧额上中回 -18 50 14 417 5.26 < 0.05 右侧颞上中回 48 -60 7 452 5.43 < 0.05 左侧颞中下回 -48 -25 -9 389 6.38 < 0.05 表 2 肺腺癌Ⅱ期组大脑静息葡萄糖代谢减低区
Table 2. Positions of the reduced glucose metabolism cerebral regions in the Ⅱstage group patients with lung adenocarcinoma
Ⅲ期组患者脑代谢减低见于左侧额上中回、右侧颞上中回、左侧颞中下回、右侧顶下小叶(图 3),脑代谢减低区域共计1810个体素数,具体分布区见表 3。
脑区 Tal坐标 素数 t值 P值 X Y Z 左侧额上中回 -22 15 42 609 5.47 < 0.05 右侧颞上中回、
顶下小叶57 -7 4 648 6.12 < 0.05 左侧颞中下回 -50 -30 -14 553 5.63 < 0.05 表 3 肺腺癌Ⅲ期组大脑静息葡萄糖代谢减低区
Table 3. Positions of the reduced glucose metabolism cerebral regions in the Ⅲstage group patients with lung adenocarcinoma
Ⅳ期组患者脑代谢减低见于左侧额上中回、右侧颞上中下回、左侧颞上中下回、右侧顶下小叶、左侧前扣带回及右侧岛回(图 4),患者脑代谢减低区域共计2910个体素数,具体分布区见表 4。
脑区 Tal坐标 素数 t值 P值 X Y Z 左侧额上中回 -25 18 48 690 5.26 < 0.05 右侧颞上中下回、
顶下小叶57 1 2 1032 5.54 < 0.05 左侧颞上中下回 -54 -21 5 865 6.48 < 0.05 左侧前扣带回 -5 46 2 140 6.59 < 0.05 右侧岛回 36 16 13 183 5.82 < 0.05 表 4 肺腺癌Ⅳ期组大脑静息葡萄糖代谢减低区
Table 4. Positions of the reduced glucose metabolism cerebral regions in the Ⅳstage group patients with lung adenocarcinoma
由上可见,肺腺癌患者随分期进展脑内异常代谢累及脑区逐渐增多,对4组脑代谢减低区域体素数进行单因素方差分析(ANOVA)显示,4组之间的差异具有统计学意义(F=25.444,P=0.0001),多重比较(LSD-t检验)结果显示,Ⅰ期组低代谢区面积分别小于Ⅱ期组(t=2.53,P=0.035)、Ⅲ期组(t=4.96,P=0.001)和Ⅳ期组(t=8.37,P=0.0001),Ⅱ期组低代谢区面积分别小于Ⅲ期组(t=2.42,P=0.042)和Ⅳ期组(t=5.84,P=0.0001),Ⅲ期组低代谢区面积小于Ⅳ期组(t=3.41,P=0.009)。
不同分期肺腺癌患者大脑静息葡萄糖代谢改变研究
Preliminary study of metabolic changes in brain glucose of patients with lung adenocarcinoma
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摘要:
目的 探讨无脑部转移的不同分期肺腺癌患者大脑静息葡萄糖代谢改变特点及其关系。 方法 回顾性分析120例组织学确诊为原发性肺腺癌患者的全身18F-FDG PET/CT检查资料, 其中Ⅰ期患者为28例、Ⅱ期29例、Ⅲ期31例和Ⅳ期32例。50名健康体检者为对照组, 分析Ⅰ、Ⅱ、Ⅲ、Ⅳ期肺腺癌患者脑葡萄糖代谢改变, 并比较4组之间脑代谢改变的差异。 结果 Ⅰ、Ⅱ、Ⅲ、Ⅳ期肺腺癌患者PET脑显像均表现区域性脑代谢减低, Ⅰ期累及脑区为左侧额上中回、右侧颞上中回、左侧颞中下回(体素数为681), Ⅱ期累及脑区为左侧额上中回、右侧颞上中回、左侧颞中下回(体素数为1258), Ⅲ期累及脑区为左侧额上中回、右侧颞上中回、左侧颞中下回、右侧顶下小叶(体素数为1810), Ⅳ期累及脑区为左侧额上中回、右侧颞上中下回、左侧颞上中下回、右侧顶下小叶、左侧前扣带回及右侧岛回(体素数为2910)。4组患者脑代谢减低区体素值差异具有统计学意义(F=25.444, P=0.0001), 且随分期增加异常代谢脑区范围逐渐增大。 结论 肺腺癌患者脑代谢减低区涉及多个与精神情感有关的功能脑区, 且其脑代谢改变与肿瘤分期具有一定相关性。 -
关键词:
- 脱氧葡萄糖F18 /
- 腺癌, 肺 /
- 正电子发射断层显像术 /
- 体层摄影术, X线计算机 /
- 脑葡萄糖代谢 /
- 统计参数地图
Abstract:Objective To investigate the metabolic changes in the resting brain glucose of patients with different stages of lung adenocarcinoma but without brain metastasis. Methods A total of 120 patients with primary untreated and histologically confirmed lung adenocarcinoma were divided into four groups based on TNM staging: stage I, 28 cases; stage II, 29 cases; stage III, 31 cases; and stage IV, 32 cases. The whole-body 18F-FDG PET/CT images of the patients were retrospectively analyzed. The brain PET data of the four groups were also examined individually and compared with those of the 50 healthy controls. Moreover, the metabolic changes in the brain glucose of the four groups were compared. Results The brain PET images showed relative reductions of the regional cerebral resting glucose metabolism of all the groups. In the stage I group, the reductions were mainly observed in the left superior-middle frontal, right superior-middle temporal, and left middle-inferior temporal gyrus. The total voxel value for this group was 681. The reductions in stage II group were evident in the left superior-middle frontal, right superior-middle temporal, and left middle-inferior temporal gyrus. The total voxel value for the stage II group was 1258. In the stage III group, reductions were evident in the left superior-middle frontal, right superior-middle temporal, left middle-inferior temporal gyrus, and right inferior parietal lobule. The total voxel value for the stage III group was 1810. In the stage IV group, reductions were evident in the left superior-middle frontal, right superior-middle-inferior temporal, left superior-middle-inferior temporal gyrus, right inferior parietal lobule, left anterior cingulated, and right insula gyrus. The total voxel value for the stage IV group was 2910. The four groups showed significantly different voxel values in their hypometabolic brain area(F=25.444, P=0.000 1), and the ranges expanded with tumor stage progression. Conclusion The reduced metabolic cerebral regions in lung adenocarcinoma patients involved a number of functional regions related to mood disorders. The ranges of the metabolic changes in the resting brain glucose in lung adenocarcinoma patients were closely correlated to different tumor stages. -
表 1 肺腺癌Ⅰ期组大脑静息葡萄糖代谢减低区
Table 1. Positions of the reduced glucose metabolism cerebral regions in the Ⅰstage group patients with lung adenocarcinoma
脑区 Tal坐标 素数 t值 P值 X Y Z 左侧额上中回 -12 59 12 218 5.34 < 0.05 右侧颞上中回 54 -62 4 276 5.21 < 0.05 左侧颞中下回 -47 -23 -21 187 6.27 < 0.05 表 2 肺腺癌Ⅱ期组大脑静息葡萄糖代谢减低区
Table 2. Positions of the reduced glucose metabolism cerebral regions in the Ⅱstage group patients with lung adenocarcinoma
脑区 Tal坐标 素数 t值 P值 X Y Z 左侧额上中回 -18 50 14 417 5.26 < 0.05 右侧颞上中回 48 -60 7 452 5.43 < 0.05 左侧颞中下回 -48 -25 -9 389 6.38 < 0.05 表 3 肺腺癌Ⅲ期组大脑静息葡萄糖代谢减低区
Table 3. Positions of the reduced glucose metabolism cerebral regions in the Ⅲstage group patients with lung adenocarcinoma
脑区 Tal坐标 素数 t值 P值 X Y Z 左侧额上中回 -22 15 42 609 5.47 < 0.05 右侧颞上中回、
顶下小叶57 -7 4 648 6.12 < 0.05 左侧颞中下回 -50 -30 -14 553 5.63 < 0.05 表 4 肺腺癌Ⅳ期组大脑静息葡萄糖代谢减低区
Table 4. Positions of the reduced glucose metabolism cerebral regions in the Ⅳstage group patients with lung adenocarcinoma
脑区 Tal坐标 素数 t值 P值 X Y Z 左侧额上中回 -25 18 48 690 5.26 < 0.05 右侧颞上中下回、
顶下小叶57 1 2 1032 5.54 < 0.05 左侧颞上中下回 -54 -21 5 865 6.48 < 0.05 左侧前扣带回 -5 46 2 140 6.59 < 0.05 右侧岛回 36 16 13 183 5.82 < 0.05 -
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