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帕金森病(Parkinson disease,PD)是一种常见于中老年人的神经系统变性疾病,临床上以静止性震颤、运动迟缓、肌强直和姿势平衡障碍为主要特征。早期准确诊断PD在临床上仍是一大难题,研究表明采用神经病理结果作为金标准临床诊断PD的准确率最高为85%[1]。常见的误诊包括两类:一类是非典型帕金森综合征(atypical parkinsonism,APS),包括多系统萎缩(multiple system atrophy,MSA)、进行性核上麻痹(progressive supranuclear palsy,PSP)、基底神经节变性;另一类是以特发性震颤(essential tremor,ET)、药物性帕金森病为代表的疾病。
PD是以基底神经节多巴胺能神经元变性为主要特征的神经变性性疾病,壳核神经元往往比尾状核神经元受累更严重,其另一大特征是自主神经系统的损害。APS与PD一样,均有突触前多巴胺能通路的变性;MSA以广泛的神经变性为特征,特别是纹状体、黑质、脑桥、下橄榄体、迷走神经运动核、小脑和脊髓;PSP的神经病理学改变主要是神经纤维结沉积在黑质纹状体通路、基底神经节、脑干核团引起的神经元变性;基底神经节变性的主要病理特征为以神经包含小体形式存在的tau蛋白的沉积。神经病理学研究显示,对比PD患者,大多数APS患者还有D2受体的丢失。ET、药物性帕金森是一类没有黑质多巴胺能变性的疾病,ET的产生可能是外周肌梭传入和中枢自律性振荡器共同作用的结果,药物性帕金森病是因为药物(如安定、某些中枢止吐药等)竞争性抑制突触后D2受体所致。
由于解剖结构的改变很轻微,PD并不能像其他的神经系统疾病一样可以通过一般的结构成像技术准确地诊断,而放射性核素显像可以在活体内定量地显示脑的功能和分子水平的变化。在过去的几十年里,大量评价放射性核素显像用于PD鉴别诊断可行性研究的结果均显示其具有较好的可行性,提示其能够更好地辅助鉴别和诊断原发性帕金森病(idiopathic Pakinson disease,IPD),降低PD的误诊率[2-4]。本文就放射性核素显像在PD鉴别诊断中的应用做一综述。
放射性核素显像在帕金森病鉴别诊断中的应用
Application of radionuclide imaging on differential diagnosis of Parkinson disease
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摘要: 帕金森病(PD)的鉴别诊断在临床上是一大难题,放射性核素显像能够为PD的鉴别诊断提供分子水平和代谢水平的信息,有助于PD与非典型帕金森综合征和特发性震颤(ET)等疾病的鉴别。笔者就放射性核素显像在PD鉴别诊断中的应用做一综述。Abstract: The differential diagnosis of Parkinson disease can be challenging. Radionuclide imaging can provide the molecular and metabolic information so that it is helpful for differential diagnosis of Parkinson disease from atypical parkinsonism or other neurological disability such as essential tremor. The application of radionuclide imaging in the differential diagnosis of Parkinson disease was reviewed in this article.
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Key words:
- Parkinson disease /
- Radionuclide imaging /
- Diagnosis, differential
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