Objective To investigate the glucose metabolic pattern of brain functional loop in patients with refractory obsessive compulsive disorder (OCD) using 18 F-FDG PET.Methods Eight patients with refractory OCD and 8 age- and gender-matched healthy volunteers underwent 18F-FDG PET brain imaging.SPM software was used for image post-processing and quantitative analysis.Correlation analysis between 18F-FDG uptake and Yale-Brown obsessive compulsive scale(Y-BOCS) score was performed.Results Compared with the controls,the glucose metabolism of bilateral frontal cortices ( including the rectal gyrus,orbital gyrus and cingulate gyrus),left thalamus,right temporal lobe and bilateral cerebellum in refractory OCD patients increased significantly ( Zmax =3.45 - 5.80,all P ＜ 0.001 ).Bilateral motor cortices and bilateral parietal lobes (BA7),however,showed decreased glucose metabolism (Zmax =3.44 - 4.46,all P ＜0.001 ).Y-BOCS score was positively correlated with the glucose metabolism of the bilateral anterior cingulate cortex (Zmax =3.77,3.48 and 2.97,all P ＜ 0.01 ).Conclusions There is a characteristic metabolic pattern of increased glucose utilization in the fronto-striato-thalamic loop and decreased glucose utilization in bilateral motor cortices and parietal lobes in patients with OCD.The glucose metabolism in the anterior cingulate cortex might serve as a quantitative parameter for the assessment of the severity of OCD.%目的 应用18F-FDG PET显像研究难治性强迫症脑内葡萄糖异常代谢区域,为临床诊疗提供客观的影像学依据.方法 对8例难治性强迫症患者和8名健康对照者进行脑18F-FDG PET显像,利用SPM软件进行对比,分析强迫症患者葡萄糖代谢改变的脑区,并对代谢变化与Yale-Brown 强迫症评定量表(Y-BOCS)评分进行相关性研究.结果 难治性强迫症患者双侧额叶皮质(包括直回、眶回及扣带回)、左侧丘脑、右侧颞叶、双侧小脑葡萄糖代谢高于健康对照组(Zmax =3.45 ～5.80,P均＜0.001)；而双侧额叶运动区皮质及双侧顶叶(BA7)呈低代谢(Zmax=3.44～4.46,P均＜0.001).Y-BOCS评分与双侧前扣带回皮质葡萄糖代谢呈正相关(Zmax=3.77,3.48,2.97,P均＜0.01).结论 难治性强迫症患者脑内额叶-纹状体-丘脑-额叶环路葡萄糖代谢增高,同时伴随双侧额叶运动区皮质及顶叶葡萄糖代谢减低；前扣带回葡萄糖代谢状态有助于评价强迫症病情的严重程度.
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