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ENGLISH ABSTRACT
痴呆症诊断的PET显像临床应用路径专家共识2024
中华医学会核医学分会
作者及单位信息
·
DOI： 10.3760/cma.j.cn321828-20240412-00131
Expert consensus on the clinical application path of PET imaging in the diagnosis of dementia 2024
Chinese Society of Nuclear Medicine
Guan Yihui
Li Sijin
Wang Jing
Authors Info & Affiliations
Chinese Society of Nuclear Medicine
Guan Yihui
Li Sijin
Wang Jing
·
DOI： 10.3760/cma.j.cn321828-20240412-00131
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摘要

痴呆症是各种病因所致认知功能障碍的总称，可分为退行性(变性病)和非退行性(非变性病)痴呆症两大类。前者主要包括阿尔茨海默病(Alzheimer′s disease, AD)、路易体痴呆(dementia with Lewy bodies, DLB)、帕金森病痴呆(Parkinson′s disease dementia, PDD)、额颞叶痴呆(frontotemporal dementia, FTD)等；后者主要包括血管性痴呆(vascular dementia, VaD)、正常压力性脑积水以及其他疾病(如颅脑损伤、感染、免疫、肿瘤、中毒和代谢性疾病等)引起的痴呆 [1]。

引用本文

中华医学会核医学分会. 痴呆症诊断的PET显像临床应用路径专家共识2024[J]. 中华核医学与分子影像杂志,2024,44(10)：609-616.

DOI:10.3760/cma.j.cn321828-20240412-00131

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痴呆症是各种病因所致认知功能障碍的总称，可分为退行性(变性病)和非退行性(非变性病)痴呆症两大类。前者主要包括阿尔茨海默病(Alzheimer′s disease, AD)、路易体痴呆(dementia with Lewy bodies, DLB)、帕金森病痴呆(Parkinson′s disease dementia, PDD)、额颞叶痴呆(frontotemporal dementia, FTD)等；后者主要包括血管性痴呆(vascular dementia, VaD)、正常压力性脑积水以及其他疾病(如颅脑损伤、感染、免疫、肿瘤、中毒和代谢性疾病等)引起的痴呆 [ 1 ]。
痴呆症临床表现错综复杂，不同疾病类型间仅靠症状进行准确甄别极具挑战。在退行性(变性病)痴呆症中，症状出现前数年至数十年就已经出现了脑内病理生理学改变，为借助病理学生物标志物进行疾病的早期精准诊断提供了契机。尽管目前尚无治愈痴呆症的方法，但精准诊断不仅有助于优化临床管理流程、提供二级预防依据、改善预后结局，还可为疾病修饰疗法的研发提供更精准的受试者入组，并有望将干预窗口大幅前移；此外，生物标志物检测有望为疾病修饰疗法的疗效评估提供客观依据。
随着靶向痴呆症关键病理底物的PET显像剂的不断研发，目前可用于临床和(或)科研的病理学靶点包括淀粉样蛋白、tau蛋白、多巴胺能系统、葡萄糖能量代谢等 [ 2 , 3 ]。联合使用不同的(PET或非PET)生物标志物可提高诊断准确性。然而，面对多样化的神经影像学生物标志物，在痴呆症的鉴别诊断和疾病管理中，如何进行不同PET显像的组合或应用顺序仍缺乏共识或理论框架。因此，中华医学会核医学分会的相关专家们结合国内外最新研究成果、我国痴呆症临床诊疗现状及PET显像技术的可及性，经多次讨论制定本专家共识，就如何将这些生物标志物排列成有意义的序列或组合，以优化其使用提供建议，供临床医师参考。
本共识根据推荐评估、制定与评价的分级(grading of recommendations assessment, development and evaluations, GRADE)标准制定证据级别和推荐等级：证据质量分为高(A)、中(B)、低(C)、极低(D)4级，推荐强度分为强(1)、弱(2)2级。本共识的证据分级与推荐强度的定义表述见 表1 。对于缺乏循证医学证据的情况，根据改良德尔菲法召开指南会议，由全国专家组成的专家委员会经过充分讨论及审查后达成推荐意见"专家共识"。
指标 具体描述 表达符号
证据质量    
高 非常有把握观察值接近真实值 A
中 对观察值有中等把握：观察值有可能接近真实值，但也有可能差别很大 B
低 对观察值的把握有限：观察值可能与真实值有很大差别 C
极低 对观察值几乎没有把握：观察值与真实值极可能有极大差别 D
推荐强度    
强 a 明确显示实施某项推荐意见利大于弊或弊大于利 1
弱 b 实施某项推荐意见的利弊不确定，或无论质量高低的证据均显示利弊相当 2
GRADE证据分级与推荐强度

注： a包括强推荐和强不推荐； b包括弱推荐和弱不推荐

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A
管一晖，Email: mocdef.labiamtohiuhiynaug；
B
李思进，Email: mocdef.3ab61.piv321mnjsil；
C
汪静，Email: mocdef.3ab6120954290931
D
所有作者声明无利益冲突
E
科技创新2030重大项目 (2022ZD0211600)
国家自然科学基金 (82394434, 82021002)
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