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目的:通过 18F-FDG脑代谢联合 18F-9-氟丙基-(＋)-二氢丁苯那嗪[FP-(＋)-DTBZ，简称DTBZ]脑囊泡单胺转运蛋白2(VMAT2)PET/CT显像研究伴或不伴快速眼动睡眠期行为障碍(RBD)的帕金森病(PD)患者显像的特点，分析其对此类PD的应用价值。 方法:前瞻性收集2022年7月至2023年6月于郑州大学第一附属医院行 18F-FDG、 18F-DTBZ PET/CT显像且经临床确诊的原发性PD患者50例，其中伴RBD的PD患者18例[PD-RBD(＋)组；男16例、女2例，年龄(59.2±9.3)岁]，不伴RBD的PD患者32例[PD-RBD(－)组；男16例、女16例，年龄(57.7±10.2)岁]，同时纳入与PD患者年龄匹配的健康对照者10名[男5名、女5名，年龄(60.3±9.6)岁]。以枕叶皮质为参考脑区，获得双侧纹状体、尾状核、前壳核、后壳核、伏隔核、黑质等脑区的 18F-DTBZ特定摄取值比(SUR)，纹状体前-后摄取梯度与其他半定量指标。采用单因素方差[最小显著差异(LSD)- t检验]、Kruskal-Wallis秩和检验(Bonferroni法校正)、两独立样本 t检验及Mann-Whitney U检验分析数据；采用Pearson相关或Spearman秩相关行相关性分析；另行ROC曲线分析；应用统计参数图(SPM)比较伴或不伴RBD的PD患者全脑葡萄糖代谢差异。 结果:与PD-RBD(－)组相比，PD-RBD(＋)组简易精神状态检查量表(MMSE)评分、PD睡眠量表(PDSS)评分均明显降低( z值：－3.12、－3.08，均 P<0.01)，其肢体症状重侧的对侧纹状体前-后摄取梯度也明显降低( t＝－2.73， P＝0.009)，SPM分析显示其对侧前额叶葡萄糖代谢升高( t值：3.11～3.57，均 P<0.001)。2组在双侧纹状体、尾状核、前壳核、后壳核、伏隔核、黑质的SUR均明显低于健康对照组( F值：6.24～147.61， H值：8.66～24.43，均 P<0.05；事后检验：LSD- t检验及Bonferroni法校正，均 P<0.01)。在PD-RBD(－)组中，对侧纹状体前-后摄取梯度与统一PD评分量表(UPDRS)评分及改良Hoehn-Yahr (mH-Y)分期呈负相关( r＝－0.35， P＝0.048； rs＝－0.39， P＝0.026)；ROC曲线分析显示以对侧纹状体前-后摄取梯度鉴别PD-RBD(＋)和PD-RBD(－)时的AUC为0.706(95% CI：0.562～0.851， P＝0.016)，灵敏度和特异性分别为59.4%(19/32)、16/18。 结论:PD-RBD(＋)组患者的对侧纹状体VMAT2前-后摄取梯度降低更明显，且2组脑代谢存在差异，提示伴与不伴RBD的PD患者可能存在不同的神经病理改变和不同的病理生理机制， 18F-DTBZ PET/CT显像可为疾病亚型的鉴别诊断提供影像学依据。

Objective:To investigate the characteristics of 18F-FDG and 18F-9-fluoropropyl-(+ )-dihydrotetrabenazine (FP-(+ )-DTBZ; short for DTBZ) brain vesicular monoamine transporter type 2 (VMAT2) PET/CT imaging and analyze its clinical diagnostic value in Parkinson′s disease (PD) patients with or without rapid eye movement sleep behaviour disorder (RBD). Methods:From July 2022 to June 2023, 50 patients clinically confirmed with primary PD who underwent 18F-FDG and 18F-DTBZ PET/CT imaging in the First Affiliated Hospital of Zhengzhou University were prospectively collected. Among them, 18 patients with PD accompanied by RBD (PD-RBD(+ ) group; 16 males, 2 females, age (59.2±9.3) years); 32 patients without RBD (PD-RBD(-) group; 16 males, 16 females, age (57.7±10.2) years). Moreover, 10 healthy controls matched with the age of PD patients were included (5 males, 5 females, age (60.3±9.6) years). 18F-DTBZ specific uptake ratio (SUR) of bilateral striatum, caudate nucleus, anterior putamen, posterior putamen, nucleus accumbens, substantia nigra and other brain regions were obtained with occipital cortex as the reference region. Striatal anterior-posterior gradient and other related semi-quantitative indicators were calculated according to the corresponding formula. One-way analysis of variance (the least significant difference (LSD)- t test), Kruskal-Wallis rank sum test (Bonferroni correction), independent-sample t test and Mann-Whitney U test were used to analyze the data. Pearson correlation and Spearman rank correlation analyses were used to evaluate the correlations. ROC curve analysis was also performed. The differences in global glucose metabolism in two groups were compared using statistical parametric mapping (SPM). Results:PD-RBD(+ ) group had a significantly lower Mini-Mental State Examination (MMSE) or PD Sleep Scale (PDSS) score than PD-RBD(-) group ( z values: -3.12, -3.08, both P<0.01), and its contralateral striatal anterior-posterior gradient of the predominantly affected limbs was significantly lower than that in PD-RBD(-) group ( t=-2.73, P=0.009). SPM analysis showed that the glucose metabolism in the contralateral prefrontal lobe was higher than that in the PD-RBD (-) group ( t values: 3.11-3.57, all P<0.001). 18F-DTBZ SUR in the bilateral striatum, caudate nucleus, anterior putamen, posterior putamen, nucleus accumbens, substantia nigra were considerably lower in both groups compared to the healthy control group ( F values: 6.24-147.61, H values: 8.66-24.43, all P<0.05; post-hoc: LSD- t test, Bonferroni correction, all P<0.01). In the PD-RBD(-) group, contralateral striatal anterior-posterior gradient were negatively correlated with unified PD Rating Scale (UPDRS) score and modified Hoehn-Yahr (mH-Y) stage ( r=-0.35, P=0.048; rs=-0.39, P=0.026). The AUC for distinguishing PD-RBD(+ ) and PD-RBD(-) with a contralateral striatal anterior-posterior gradient was 0.706 (95% CI: 0.562-0.851, P=0.016), with the sensitivity and specificity of 59.4%(19/32) and 16/18, respectively. Conclusions:The decrease of contralateral striatal anterior-posterior gradient of VMAT2 is more obvious in patients with PD-RBD(+ ), and there are differences in brain metabolism between the two groups, suggesting that there may be different neuropathological changes and different pathophysiological mechanisms between PD patients with and without RBD. 18F-DTDZ PET/CT can provide imaging basis for the differential diagnosis of the disease subtypes.