Article(id=1208862462825329432, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208862455166538583, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2021.08.14, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1609171200000, receivedDateStr=2020-12-29, revisedDate=1622044800000, revisedDateStr=2021-05-27, acceptedDate=null, acceptedDateStr=null, onlineDate=1766144870716, onlineDateStr=2025-12-19, pubDate=1630080000000, pubDateStr=2021-08-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1766144870716, onlineIssueDateStr=2025-12-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1766144870716, creator=13701087609, updateTime=1766144870716, updator=13701087609, issue=Issue{id=1208862455166538583, tenantId=1146029695717560320, journalId=1189873630562394117, year='2021', volume='46', issue='8', pageStart='743', pageEnd='848', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1766144868890, creator=13701087609, updateTime=1766144939527, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1208862751481524455, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208862455166538583, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1208862751481524456, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208862455166538583, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=827, endPage=830, ext={EN=ArticleExt(id=1208862463320257320, articleId=1208862462825329432, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Research progress of PET molecular imaging in rimmed vacuolar myopathy, columnId=1190243275882729994, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Review, runingTitle=null, highlight=null, articleAbstract=

Rimmed vacuole myopathy is a group of disease with characteristic myopathological features, which including deposition of abnormal proteins, such as β-amyloid protein (Aβ) and phosphorylated tau proteins etc. In recent years, positron emission tomography (PET) has been widely used in the imaging diagnosis of Alzheimer's disease (AD) due to the development of molecular imaging technology. Recently, some studies have indicated that molecular imaging PET can also show the abnormal deposition proteins in muscles, which is helpful for the early diagnosis and differential diagnosis of rimmed vacuolar myopathy, and provides a new application for PET. The application directions of PET in rimmed vacuolar myopathy were reviewed in this article, in order to provide a reference base for the implementation of clinical work.

, correspAuthors=Qiang Shi, authorNote=null, correspAuthorsNote=
*E-mail:
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镶边空泡肌病是具有特征性骨骼肌病理特点的一组疾病,其病理特点之一为β淀粉样蛋白(Aβ)及磷酸化tau蛋白在肌纤维中的异常沉积。近年来得益于分子影像技术的发展,正电子断层显像技术(PET)已被广泛应用于阿尔茨海默病的影像诊断,分子影像PET亦可以显示肌肉内沉积的异常蛋白,有助于镶边空泡肌病的早期诊断及鉴别诊断,为PET提供了新的应用方向。该文主要对PET在镶边空泡肌病中的应用进展进行综述,以期为临床工作的实施提供参考依据。

, correspAuthors=石强, authorNote=null, correspAuthorsNote=
石强,E-mail:
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李珂,博士研究生,主要从事神经肌肉疾病方面的研究

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李珂,博士研究生,主要从事神经肌肉疾病方面的研究

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李珂,博士研究生,主要从事神经肌肉疾病方面的研究

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J Neurol Neurosurg Psychiatry, 2011, 82(9): 1060-1062., articleTitle=Increased 11C PIB-PET levels in inclusion body myositis are indicative of amyloid beta deposition, refAbstract=null), Reference(id=1208862470756757590, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862462825329432, doi=null, pmid=null, pmcid=null, year=2020, volume=39, issue=5, pageStart=243, pageEnd=244, url=null, language=null, rfNumber=[18], rfOrder=19, authorNames=Li K, Dang H, Shi Q, journalName=Clin Neuropathol, refType=null, unstructuredReference=Li K, Dang H, Shi Q. 11C-PIB PET of inclusion body myositis:Molecular imaging of amyloid beta expression improving imaging-pathology correlations[J]. 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Curr Rheumatol Rep, 2019, 21(11): 64., articleTitle=PET scan: nuclear medicine imaging in myositis, refAbstract=null), Reference(id=1208862471050358876, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862462825329432, doi=null, pmid=null, pmcid=null, year=2019, volume=78, issue=5, pageStart=657, pageEnd=662, url=null, language=null, rfNumber=[21], rfOrder=22, authorNames=Lilleker JB, Hodgson R, Roberts M, journalName=Ann Rheum Dis, refType=null, unstructuredReference=Lilleker JB, Hodgson R, Roberts M, et al. 18F Florbetapir positron emission tomography: identification of muscle amyloid in inclusion body myositis and differentiation from polymyositis[J]. Ann Rheum Dis, 2019, 78(5): 657-662., articleTitle=18F Florbetapir positron emission tomography: identification of muscle amyloid in inclusion body myositis and differentiation from polymyositis, refAbstract=null), Reference(id=1208862471146827872, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862462825329432, doi=null, pmid=null, pmcid=null, year=2020, volume=99, issue=31, pageStart=e21524, pageEnd=null, url=null, language=null, rfNumber=[22], rfOrder=23, authorNames=Zhang YT, Li K, Pu CQ, journalName=Medicine (Baltimore), refType=null, unstructuredReference=Zhang YT, Li K, Pu CQ, et al. A novel application of tau PET in the diagnosis of sporadic inclusion body myositis: a case report[J]. 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SUV. 标准化摄取值;箭头指示为AD组典型的低代谢(FDG)及典型的淀粉样沉积(PIB)

, figureFileSmall=2GCuf9kDV1RimFdFUumVIw==, figureFileBig=awpB6LY6NKHZp7xIb6A/aQ==, tableContent=null), ArticleFig(id=1208862466998662129, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862462825329432, language=EN, label=Fig.2, caption=11C-PIB PET/CT scans of sporadic inclusion body myositis patient and myalgia patient of unclear aetiology[17], figureFileSmall=+VNZd7X6VAZjzwqYsX6nhg==, figureFileBig=7ibM1GhhcEIkhXTZoP+akw==, tableContent=null), ArticleFig(id=1208862467069965303, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862462825329432, language=CN, label=图2, caption=散发性包涵体肌炎患者与不明原因肌痛患者的11C-PIB PET/CT图像[17]

A. 散发性包涵体肌炎患者(腓肠肌标准化摄取值SUV=0.73);B. 不明原因肌痛患者(腓肠肌SUV=0.45)

, figureFileSmall=+VNZd7X6VAZjzwqYsX6nhg==, figureFileBig=7ibM1GhhcEIkhXTZoP+akw==, tableContent=null), ArticleFig(id=1208862467162239992, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862462825329432, language=EN, label=Fig.3, caption=18F-florbetapir PET/CT images of patient with sporadic inclusion body myositis (A) and patient with polymyositis (B)[21], figureFileSmall=DilCClThI23ft1DcEWx2/Q==, figureFileBig=GcXZJ6g5ln6T8S8u8M7YWw==, tableContent=null), ArticleFig(id=1208862468386976763, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862462825329432, language=CN, label=图3, caption=散发性包涵体肌炎患者与多发性肌炎患者的18F-florbetapir PET/CT图像[21]

与多发性肌炎患者比较,散发性包涵体肌炎患者SUV值明显增高;红色表明示踪剂摄取增加

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正电子断层显像技术在镶边空泡肌病中的应用研究进展
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李珂 1 , 石强 2, *
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解放军医学杂志 | 综述 2021, 46(8): 827-830
正电子断层显像技术在镶边空泡肌病中的应用研究进展
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李珂1, 石强2, *
作者信息
  • 1解放军总医院第二医学中心神经内科,北京 100853
  • 2解放军总医院第一医学中心神经内科,北京 100853
  • 李珂,博士研究生,主要从事神经肌肉疾病方面的研究

通讯作者:

石强,E-mail:
Research progress of PET molecular imaging in rimmed vacuolar myopathy
Ke Li1, Qiang Shi2, *
Affiliations
  • 1Department of Neurology, the Second Medical Center of PLA General Hospital, Beijing 100853, China
  • 2Department of Neurology, the First Medical Center of PLA General Hospital, Beijing 100853, China
出版时间: 2021-08-28 doi: 10.11855/j.issn.0577-7402.2021.08.14
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镶边空泡肌病是具有特征性骨骼肌病理特点的一组疾病,其病理特点之一为β淀粉样蛋白(Aβ)及磷酸化tau蛋白在肌纤维中的异常沉积。近年来得益于分子影像技术的发展,正电子断层显像技术(PET)已被广泛应用于阿尔茨海默病的影像诊断,分子影像PET亦可以显示肌肉内沉积的异常蛋白,有助于镶边空泡肌病的早期诊断及鉴别诊断,为PET提供了新的应用方向。该文主要对PET在镶边空泡肌病中的应用进展进行综述,以期为临床工作的实施提供参考依据。

镶边空泡肌病  /  正电子断层显像技术  /  β淀粉样蛋白  /  tau蛋白

Rimmed vacuole myopathy is a group of disease with characteristic myopathological features, which including deposition of abnormal proteins, such as β-amyloid protein (Aβ) and phosphorylated tau proteins etc. In recent years, positron emission tomography (PET) has been widely used in the imaging diagnosis of Alzheimer's disease (AD) due to the development of molecular imaging technology. Recently, some studies have indicated that molecular imaging PET can also show the abnormal deposition proteins in muscles, which is helpful for the early diagnosis and differential diagnosis of rimmed vacuolar myopathy, and provides a new application for PET. The application directions of PET in rimmed vacuolar myopathy were reviewed in this article, in order to provide a reference base for the implementation of clinical work.

rimmed vacuole myopathy  /  positron emission tomography  /  β-amyloid  /  tau protein
李珂, 石强. 正电子断层显像技术在镶边空泡肌病中的应用研究进展. 解放军医学杂志, 2021 , 46 (8) : 827 -830 . DOI: 10.11855/j.issn.0577-7402.2021.08.14
Ke Li, Qiang Shi. Research progress of PET molecular imaging in rimmed vacuolar myopathy[J]. Medical Journal of Chinese People’s Liberation Army, 2021 , 46 (8) : 827 -830 . DOI: 10.11855/j.issn.0577-7402.2021.08.14
镶边空泡肌病是指在病理学上观察到的以肌纤维内出现一种特殊空泡为表现的肌肉病[1],其发病机制可能为病毒感染、肌肉退行性改变、蛋白质稳态异常、人类白细胞抗原(HLA)基因型、自噬作用等促使细胞发生应激反应,以及某些异常蛋白[如β淀粉样蛋白(β-amyloid protein,Aβ)、泛素、磷酸化tau蛋白及载脂蛋白E等]在肌细胞中沉积等[2]。镶边空泡肌病是一种比较复杂的肌病,根据不同的病变部位、病因及基因突变情况,可分为不同的类型:获得性镶边空泡肌病,即散发性包涵体肌炎(sporadic inclusion body myositis,sIBM),以及遗传性镶边空泡肌病(hereditary inclusion body myopathy,hIBM)。hIBM包括如下几类:(1)包涵体肌病(inclusion body myopathy,IBM):①伴镶边空泡远端肌病(distal myopathy with rimmed vacuole,DMRV)、股四头肌不受累的镶边空泡肌病、Nonaka肌病或IBM2[3];②肌球蛋白重链Ⅰα病,也称IBM3型、伴眼外肌麻痹的近端肌病[4];③伴Paget骨病和额颞叶痴呆的包涵体肌病(inclusion body myopathy associated with Paget disease of the bone and frontotemporal dementia,IBMPFD)[5];④Welander远端肌病[6];⑤胫前肌营养不良[7];⑥眼咽型远端肌病[8]。(2)肌营养不良:①眼咽型肌营养不良;②X连锁Emery-Dreifuss肌营养不良;③肢带型肌营养不良(limb-girdle muscular dystrophy,LGMD),其中LGMDlA、LGMDlD、LGMDlF、LGMDlG、LGMD2G病理可见镶边空泡;④伴镶边空泡的远端肌营养不良。(3)肌原纤维肌病[9]。(4)远端型肌病。(5)其他:①还原体肌病;②伴姿势性肌萎缩的X连锁肌病。
骨骼肌活检在此类疾病的诊断中有着不可替代的价值,但肌肉活检为有创操作,在实际应用中受到取材部位及取材标本量的限制,无法准确判断疾病的全貌,存在漏诊的可能。近期有研究发现镶边空泡肌病与阿尔茨海默病(Alzheimer's disease,AD)有类似的病理表现,有多种异常蛋白质包括Aβ、tau蛋白等在肌纤维内沉积,这些异常沉积的蛋白质是疾病特征性的分子标志[10]。因此,整合骨骼肌传统病理及靶向于Aβ、tau蛋白的无创体内分子影像检查技术,将对疾病的诊断与鉴别、整体病情评估及早期治疗提供强有力的保障。基于此,本文对镶边空泡肌病与AD发病机制的关联以及正电子发射断层显像(positron emission tomography,PET)在镶边空泡肌病中的研究进展进行综述。
在镶边空泡肌病的骨骼肌中可以观察到Aβ、磷酸化tau蛋白及载脂蛋白E等在肌纤维中沉积[2]。近期多个研究提示,镶边空泡肌病与AD在病理、发病机制方面存在一定的关联。
sIBM与AD的生物化学特征均是存在Aβ、tau蛋白的沉积,病理特征均为空泡改变,包括sIBM的镶边空泡(rimmed vacuoles,RVs)及AD的颗粒空泡变性。海马锥体神经元发生颗粒空泡变性是AD的病理标志之一,颗粒由多种蛋白组成,包括与tau相关的自噬、多种信号转导途径、细胞应激及凋亡相关蛋白。Askanas等[10]发现,sIBM患者肌肉纤维的镶边空泡伴有多种蛋白聚集,如Aβ、磷酸化tau蛋白,类似于AD中变性海马锥体细胞的成对螺旋丝。
研究发现,IBM常合并其他神经系统变性病痴呆,如IBMPFD是镶边空泡肌病中的一种类型,呈常染色体显性遗传,32%的IBMPFD伴有额颞叶痴呆,影像学显示骨溶解及额颞叶萎缩,肌肉病理可见镶边空泡、包涵体[5]。文献报道1例73岁老年女性患者,初诊断为sIBM,最后发展为AD,提示有少数患者为sIBM与AD先后共患,此两种疾病在病因学方面有内在联系[11]
总之,镶边空泡肌病与AD在发病机制及病理方面有关联性,目前PET检查在AD诊断、鉴别诊断及病情评估等方面的应用价值已得到临床公认,但其在骨骼肌相关疾病中的临床应用尚少。
PET的原理是应用示踪标记短半衰期的放射性同位素,将体内细胞、组织及器官的生理及病理状况以三维成像的形式灵敏而特异地反映出来[12]。目前,在镶边空泡肌病中,临床应用的PET检查项目主要有三种。
18F-FDG PET是利用18F-FDG标记葡萄糖等人体代谢物,通过检测组织的标准化摄取值(standard uptake value,SUV)来反映病变的性质。18F-FDG PET是目前较常用的肿瘤筛查技术,能够准确地反映体内器官或组织的葡萄糖代谢水平,通常用于检测肌病患者肌肉组织病变的活动性及恶性肿瘤的筛查。18F-FDG PET最大的优点是可以同时进行全身扫描,除广泛应用于筛查sIBM患者相伴的恶性肿瘤性疾病,还可用于评估sIBM患者肌肉疾病的活动度及监测病情的进展。Matuszak等[13]分析了34例特发性炎性肌病患者的全身18F-FDG PET检查,通过测量患者的四肢近端肌肉最大SUV,并与20例良性肺结节患者对比,结果发现,特发性炎性肌病患者的最大SUV高于对照组,肌肉组织对脱氧葡萄糖(fluorodeoxyglucose,FDG)的摄取可以反映患者肌肉疾病活动度的高低,18F-FDG PET可用于监测患者肌肉疾病的活动度。
淀粉样蛋白PET示踪剂可与Aβ结合,直观反映活体组织的Aβ分布模式,使得从分子影像及病理学角度早期发现并预测疾病成为可能。目前较成熟的检测Aβ斑块的示踪剂是11C-匹兹堡化合物B(Pittsburgh compound B,11C-PIB)[14]18F-florbetapir (18F-AV45)[15],二者均为靶向于Aβ的分子显像探针,可以显示AD患者脑中的老年斑 (图1)。11C-PIB可以透过细胞膜,测定肌肉组织内Aβ的密度,并能区分出高密度及低密度的Aβ。11C-PIB PET也可应用于心肌的Aβ体内显像[16]
在sIBM的PET分子影像学研究方面,Maetzler等[17]应用11C-PIB PET进行6例sIBM患者骨骼肌的体内Aβ显像,结果发现,sIBM患者下肢肌肉11C-PIB PET的SUV值(均>0.6)明显高于不明原因肌痛患者(均<0.5),差异有统计学意义(P=0.004,图2)。近年来,11C-PIB PET在sIBM诊断方面的价值得到了其他研究的进一步验证[18-19]
另外一种靶向于Aβ的PET是18F-AV45 PET,18F-AV45的半衰期更长[20]。有研究对10例sIBM患者与6例多发性肌炎(polymyositis,PM)患者进行了18F-PET及骨骼肌MRI检查,评估了感兴趣区域(region of interest,ROI)SUV的差异及其与疾病严重程度之间的关系。结果发现,sIBM患者ROI的SUV高于PM患者[1.45(1.28~2.05) vs. 1.01(0.80~1.22),P=0.005]。以SUV=1.28作为界定值,其诊断sIBM的敏感度、特异度分别为80%、100%。该研究证实18F-AV45 PET肌肉淀粉样蛋白成像在sIBM与其他炎性肌病的鉴别诊断方面是有效的(图3)[21]
tau蛋白是一种高度可溶的微管相关蛋白,其磷酸化受多种激酶调节,包括蛋白激酶、丝氨酸激酶、苏氨酸激酶等,当蛋白激酶激活时可引起微管组织破坏,造成神经原纤维变性。在AD及镶边空泡肌病中,也有tau蛋白的过度沉积。tau PET示踪剂可与这些异常折叠的tau蛋白相结合,从病理学角度阐明tau蛋白与疾病的关系。目前常用的tau蛋白放射示踪剂有18F-THK5317、18F-THK5351、18F-AV1451及11C-PBB3等。
tau蛋白的异常沉积在AD中最常见,在其他神经系统变性疾病如进行性核上性麻痹、皮质基底综合征、唐氏综合征、帕金森病及路易体痴呆中亦可见。目前国内外尚未见tau蛋白PET显像在肌病方面的研究报道。本课题组完成了1例sIBM患者的18F-THK5317 PET/MRI检查,结果显示,sIBM患者双侧股四头肌tau蛋白的SUV为0.73/0.67(右/左),大腿后组肌肉SUV<0.5,提示股四头肌摄取tau水平明显高于大腿后部肌群,符合包涵体肌炎肌肉受累的临床特点,提示18F-THK5317 PET/MRI可揭示体内肌肉tau蛋白沉积的特点[22]
PET技术在镶边空泡肌病诊断及鉴别诊断中逐渐显示出巨大的临床应用价值,但仍有以下问题需要进一步研究。首先,目前尚无标准化的PET影像定量分析方法,需要进一步探究PET显像方法(如FDG PET、Aβ PET、tau蛋白PET)与MRI序列在镶边空泡肌病临床应用方面的最优组合方式,以及PET/MRI在定量分析方面的可靠性;其次,需要合成更具病变特异性及组织高亲和力的PET放射示踪剂;第三,随着多模态影像数据处理及分析方法的兴起以及PET/MRI的发展,未来PET、PET/MRI的价值将不仅局限于镶边空泡肌病的早期诊断,还有望在镶边空泡肌病病情严重程度分级及监测疾病进展方面发挥更大作用。
  • 国家自然科学基金青年项目(81601086)
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doi: 10.11855/j.issn.0577-7402.2021.08.14
  • 接收时间:2020-12-29
  • 首发时间:2025-12-19
  • 出版时间:2021-08-28
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  • 收稿日期:2020-12-29
  • 修回日期:2021-05-27
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National Natural Science Foundation of China(81601086)
国家自然科学基金青年项目(81601086)
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    1解放军总医院第二医学中心神经内科,北京 100853
    2解放军总医院第一医学中心神经内科,北京 100853

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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