路易体痴呆与阿尔茨海默病中医证候及脑葡萄糖代谢对比研究
Comparison of traditional Chinese medicine patterns and brain glucose metabolism between dementia with Lewy bodies and Alzheimer’s disease
- 北京中医药大学学报 2023年46卷第3期 页码：397-405
- 作者机构：
1.首都医科大学宣武医院 北京 100053
2.上海中医药大学附属龙华医院
3.北京中医药大学第三附属医院
- 作者简介：
王晶，女，在读博士生
#曲淼，男，博士，教授，主任医师，博士生导师，主要研究方向：神经系统疾病的中医药防治，E-mail：qumiao@xwhosp.org
- 基金信息：国家重点研发计划项目(2020YFC2003100;2020YFC2003103)
DOI：10.3969/j.issn.1006-2157.2023.03.017
中图分类号： R259纸质出版日期：2023-03-30，
收稿日期：2022-09-04，
- 稿件说明：
移动端阅览
王晶, 于跃怡, 杨宏伟, 等. 路易体痴呆与阿尔茨海默病中医证候及脑葡萄糖代谢对比研究[J]. 北京中医药大学学报, 2023,46(3):397-405.
WANG Jing, YU Yueyi, YANG Hongwei, et al. Comparison of traditional Chinese medicine patterns and brain glucose metabolism between dementia with Lewy bodies and Alzheimer’s disease[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023,46(3):397-405.
王晶, 于跃怡, 杨宏伟, 等. 路易体痴呆与阿尔茨海默病中医证候及脑葡萄糖代谢对比研究[J]. 北京中医药大学学报, 2023,46(3):397-405. DOI： 10.3969/j.issn.1006-2157.2023.03.017.
WANG Jing, YU Yueyi, YANG Hongwei, et al. Comparison of traditional Chinese medicine patterns and brain glucose metabolism between dementia with Lewy bodies and Alzheimer’s disease[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023,46(3):397-405. DOI： 10.3969/j.issn.1006-2157.2023.03.017.
摘要
目的
2
通过分析路易体痴呆和阿尔茨海默病患者的中医证候和脑葡萄糖代谢，找到有效鉴别诊断二者的特征及中医辨证分型的客观依据。
方法
2
2020年1月—2020年12月共纳入符合标准的患者60例，其中路易体痴呆患者30例，阿尔茨海默病患者30例。采集患者的一般人口学资料，通过临床痴呆评定量表(CDR)总分评定患者痴呆的严重程度及痴呆证候要素加权量表确定患者的证候类型，静脉注射示踪剂
18
F－氟代脱氧葡萄糖后行正电子发射计算机体层显像。
结果
2
路易体痴呆患者以阴虚阳亢证、肺肾气虚证、肝肾亏虚证居多，阿尔茨海默病患者以脾虚痰浊证、热毒血瘀证、脾肾两虚证居多。可疑痴呆的路易体痴呆患者主要为顶叶和颞叶代谢减低；轻中度痴呆的路易体痴呆患者主要为额叶、顶叶和颞叶代谢减低；非重度痴呆的阿尔茨海默病患者主要为顶叶、颞叶、额叶代谢减低，而部分中度痴呆的阿尔茨海默病患者会出现枕叶代谢减低；路易体痴呆患者中，阴虚阳亢证者主要是额叶、顶叶、颞叶、枕叶的代谢减低，肺肾气虚证者主要是额叶、顶叶、颞叶的代谢减低，肝肾亏虚证者主要是顶叶、颞叶代谢减低，而阿尔茨海默病不同中医证候患者多以额叶、顶叶、颞叶低代谢为主。
结论
2
路易体痴呆和阿尔茨海默病患者中医证候类型和脑葡萄糖代谢特征差异明显，有助于鉴别诊断，不同证候路易体痴呆患者脑代谢特征有所差异，有助于对其的精准化治疗。
Abstract
Objective
2
By analyzing the traditional Chinese medicine syndrome and cerebral glucose metabolism of dementia with lewy bodies(DLB) and Alzheimer's disease (AD)
this study intends to find the features of effective differential diagnosis of DLB and AD.
Methods
2
From January 2020 to December 2020
a total of 60 patients meeting the criteria were included
including 30 patients with DLB and 30 patients with AD.The general demographic data of the patients were collected. The total score of the Clinical Dementia Rating Scale (CDR) was used to assess the severity of dementia and the dementia syndrome factor weighting scale was used to determine the syndrome types of the patients. Positron emission computer tomography was performed after intravenous injection of the tracer
18
F-fluorodeoxyglucose.
Results
2
Yin deficiency and yang hyperactivity
qi deficiency of lung and kidney
liver-kidney deficiency were the most common syndromes in DLB patients.The syndromes of spleen deficiency and phlegm turbid
heat-toxity and blood stasis
spleen-kidney deficiency were the most common in AD patients. The changes of brain metabolism in DLB patients with suspected dementia were mainly reduced in the parietal lobe and temporal lobe. The metabolism of frontal
parietal and temporal lobes was decreased in DLB patients with mild and moderate dementia. In AD patients with non-severe dementia
the metabolism of the parietal lobe
temporal lobe and frontal lobe is decreased
while in some AD patients with moderate dementia
the metabolism of the occipital lobe is decreased.In patients with DLB
the changes in brain metabolism in patients with syndrome of yin deficiency and yang hyperactivity were mainly reduced metabolism in frontal lobe
parietal lobe
temporal lobe and occipital lobe; the changes in brain metabolism in patients with syndrome of qi deficiency of lung and kidney were mainly reduced metabolism in frontal lobe
parietal lobe and temporal lobe; the changes in brain metabolism in patients with liver-kidney deficiency syndrome were mainly reduced metabolism in parietal lobe and temporal lobe. However
patients with AD with different TCM syndromes mainly have low metabolism in frontal lobe
parietal lobe and temporal lobe.
Conclusion
2
There are significant differences in TCM syndrome and cerebral glucose metabolism characteristics between DLB and AD patients
which is helpful for the differential diagnosis of DLB and AD. The brain metabolic characteristics of DLB patients with different syndromes are different
which is conducive to the precise treatment of DLB.
关键词
路易体痴呆阿尔茨海默病中医证候正电子发射计算机体层显像
Keywords
dementia with Lewy bodiesAlzheimer’s diseaseTCM patternpositron emission tomography and computed tomography
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