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淀粉样蛋白PET脑显像技术规范专家共识
中华医学会核医学分会
北京认知神经科学学会
作者及单位信息
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DOI： 10.3760/cma.j.cn321828-20200415-00150
Expert consensus on technical specifications of amyloid PET brain imaging
Chinese Society of Nuclear Medicine
Beijing Cognitive Neuroscience Society
Han Ying
Li Sijin
Li Yaming
Authors Info & Affiliations
Chinese Society of Nuclear Medicine
Beijing Cognitive Neuroscience Society
Han Ying
Li Sijin
Li Yaming
·
DOI： 10.3760/cma.j.cn321828-20200415-00150
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摘要

阿尔茨海默病(Alzheimer′s disease, AD)是一种起病隐匿、持续进展的神经退行性脑病，临床以情景记忆障碍为早期突出的核心症状，继而出现多种认知功能和非认知功能损害 [ 1 , 2 ] 。研究证实，AD相关神经病理学改变最早可于典型症状出现前的20年发现，因此AD被看作是连续过程，其疾病谱包括无显著临床症状阶段的临床前AD阶段(preclinical AD)至前驱期AD(prodromal AD)或AD源性轻度认知障碍(mild cognitive impairment, MCI)，再至典型痴呆阶段[AD源性痴呆(AD dementia, ADD)]的连续过程 [ 3 , 4 , 5 , 6 ] 。

引用本文

中华医学会核医学分会,北京认知神经科学学会. 淀粉样蛋白PET脑显像技术规范专家共识[J]. 中华核医学与分子影像杂志,2020,40(12)：736-742.

DOI:10.3760/cma.j.cn321828-20200415-00150

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阿尔茨海默病(Alzheimer′s disease, AD)是一种起病隐匿、持续进展的神经退行性脑病，临床以情景记忆障碍为早期突出的核心症状，继而出现多种认知功能和非认知功能损害 [ 1 , 2 ]。研究证实，AD相关神经病理学改变最早可于典型症状出现前的20年发现，因此AD被看作是连续过程，其疾病谱包括无显著临床症状阶段的临床前AD阶段(preclinical AD)至前驱期AD(prodromal AD)或AD源性轻度认知障碍(mild cognitive impairment, MCI)，再至典型痴呆阶段[AD源性痴呆(AD dementia, ADD)]的连续过程 [ 3 , 4 , 5 , 6 ]。
由β-淀粉样蛋白(β-amyloid, Aβ)聚集形成老年斑和异常过度磷酸化tau蛋白组成的神经原纤维缠结是AD两大神经病理变化 [ 7 ]。Aβ级联假说是AD的主要假说之一，是指在AD进程中Aβ异常沉积作为始动因素，可继发引起tau蛋白异常过度磷酸化、神经递质紊乱以及氧化应激等众多神经病理学和(或)病理生理学过程，并最终导致大量神经元变性死亡和功能障碍，造成认知功能下降、精神行为症状及日常生活能力减退等临床表现 [ 8 ]。
PET显像通过正电子核素标记的显像剂特异性结合病理学和(或)病理生理学生物标志物来实现活体分子显像，提供可定量与可视化的生物信息 [ 9 , 10 , 11 , 12 , 13 , 14 ]。最早成功的Aβ PET显像剂 11C-匹兹堡化合物B(Pittsburgh compound B, PIB)是Aβ染色剂硫黄素T的衍生物 [ 15 ]。近年来，3种 18F标记的显像剂florbetaben [ 16 ](即AV-1，商品名NeuraCeq)、florbetapir [ 17 ](即AV-45，商品名Amyvid)、flutemetamol [ 18 ](即GE-067，商品名Vizamyl)在多个国家和地区相继被批准用于Aβ PET临床显像。
早期PET研究结果显示，与正常志愿者及其他类型痴呆如额颞叶痴呆(frontotemporal lobe dementia, FTLD)患者相比，AD患者大脑皮质Aβ沉积程度显著升高，这与神经病理学检查结果相吻合，因此Aβ PET显像开始被用于AD的临床诊断和鉴别诊断 [ 19 , 20 ]。然而，也有研究发现路易体痴呆(dementia with Lewy bodies, DLB)和淀粉样脑血管病(cerebral amyloid angiopathy, CAA)患者的Aβ PET显像可呈阳性，故不推荐Aβ PET显像用于DLB、CAA与AD的鉴别诊断 [ 21 , 22 ]。目前，对于Aβ PET显像临床应用指征的相关建议也已出台 [ 23 , 24 ]。
随访研究发现，Aβ PET显像阳性的遗忘性MCI(amnestic MCI, aMCI)患者未来转化为AD的概率显著高于Aβ PET显像阴性者 [ 25 , 26 ]，且aMCI阶段和主观认知下降(subjective cognitive decline, SCD)阶段患者的脑内Aβ沉积程度与其情景记忆障碍和其他认知障碍严重程度显著相关 [ 27 , 28 ]。此外，载脂蛋白E(apolipoprotein E, APOE)ε4等位基因或APOEε4基因型增加了患者Aβ PET显像阳性的风险 [ 29 ]。因此，Aβ PET显像对于AD高危人群的早期识别、转归预测和早期干预有潜在的应用价值，也越来越受到重视。
本共识旨在提倡并推动Aβ PET显像技术规范化，以实现显像流程及结果的可靠性、可重复性及可比性，为开展AD及相关疾病的临床科学研究提供重要的技术支撑。
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备注信息
A
韩璎，Email: nc.defudabe.umcc.hwxgniynah
B
李思进，Email: mocdef.3ab61.piv321mnjsil
C
李亚明，Email： mocdef.3ab611002ilmy
D
所有作者均声明不存在利益冲突
E
国家自然科学基金 (61633018, 81971641, 81725009, 81271516, 61603236)
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