帕金森病不同运动表型与认知障碍关系及其机制的研究  

Investigation on association of motor phenotypes and cognitive impairment in parkinson disease and the potential mechanisms

作　　者：左丽君[1] 扈杨 余舒扬[2] 连腾宏 王方[1] 朴英善[2] 王瑞丹[1] 余秋瑾 郭鹏[2] 李丽霞[2] 金朝[1] 朱荣彦[1] 杜阳[1] 张巍[2] Zuo Lijun Hu yang Yu Shuyang Lian Tenghong Wang Fang Piao Yingshan Wang Ruidang Yu Qiujun Guo Peng Li Lixia Jin Zhao Zhu Rongyan Du Yang Zhang Wei(Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China)

机构地区：[1]首都医科大学附属北京天坛医院神经病学中心,100050 [2]首都医科大学附属北京天坛医院老年病科,100050

出　　处：《北京医学》2016年第10期1003-1008,共6页Beijing Medical Journal

摘　　要：目的探索帕金森病(Parkinson disease,PD)患者震颤型与姿势步态异常型等不同运动表型与认知功能之间的关系及其机制。方法选择110例PD患者,采用统一帕金森病评分量表评价运动症状,并分为震颤型(tremor-dominant,TD)70例,姿势步态异常型(postural instability and gait difficulty,PIGD)40例;采用一系列非运动症状量表评价非运动症状;检测110例PD患者脑脊液中β淀粉样蛋白(βamyloid,Aβ)1-42、总tau、磷酸化tau蛋白,磷酸化位点分别是:231苏安酸位点(P-tau231t)、181苏安酸位点(P-tau181t)、396丝氨酸位点(P-tau396s)和199丝氨酸位点(P-tau199s)水平的变化;将(total tau,T-tau)震颤评分和姿势步态异常评分与脑脊液中上述病理蛋白水平进行相关性分析。结果 (1)PIGD组患者姿势步态异常、强直和运动迟缓评分较TD组明显升高,而震颤评分明显下降,MoC A中注意力评分明显低于TD组,生活质量较TD组患者下降更明显。(2)PIGD组和TD组脑脊液中总tau、P-tau231t、P-tau181t、P-tau396s和P-tau199s水平较对照组显著升高(P<0.05);脑脊液中Aβ1-42水平较对照组明显降低;PIGD组P-tau181t水平较TD组和对照组显著升高,Aβ1-42水平较TD组和对照组显著降低(P<0.05)。(3)单因素分析发现,PD患者姿势步态异常评分与脑脊液P-tau181t水平、H-Y分期、病程、焦虑、抑郁、疲劳及淡漠呈显著正相关,与脑脊液Aβ1-42及认知功能呈显著负相关;多重线性回归分析发现,PIGD组患者姿势步态异常评分与脑脊液中P-tau181t水平、H-Y分期呈显著正相关,与Mo CA水平呈显著负相关(P<0.05)。结论 PIGD组患者,姿势步态异常、强直和运动迟缓均明显重于TD组,生活质量较TD组明显下降。PD患者姿势步态异常表型与脑脊液中P-tau181t水平呈正相关,与脑脊液中Aβ1-42水平呈负相关;PIGD组患者较TD患者更易发生认知障碍,Aβ1-42过量沉积与脑内脑脊液中P-tau181t水平升高,导致认知相关脑区神经�Objective Parkinson disease （PD） is a common neurodegenerative disease with great clinical heterogeneity, and can mainly be identified as tremor-dominant （TD） and postural instability and gait difficulty （PIGD） phenotypes based on motor symptoms. This study was aimed to investigate the relationship between motor phenotypes and cognitive impairments and explore the potential underlying mechanisms. Methods 110 PD patients in total were evaluated by Unified Parkinson＇s Disease Rating Scale （UPDRS）, scales related to motor and non-motor symptoms. Seventy PD patients were diagnosed as the TD group and 40 PD patients were diagnosed as PIGD group. The levels of pathological proteins, including β-amyloid （Aβ）1.42, total tau （t-tau）, and tau phosphorylated at position of threonine 181 （P-taul 81 t ）, threonine 231 （P-tau231 t）, serine 396 （P-tau396s） and serine 199 （P-tau199s） in CSF samples from 110 PD patients were measured. Linear regression analyses were performed between motor score and the levels of above measured factors in CSF from PD patients. Results （1） PIGD group displayed higher scores of PIGD, rigidity and bradykinesia, and lower scores of tremor and attention in MoCA than the TD group, while the PIGD group had poorer life quality than the TD group. （2） TD group and PIGD groups had significantly higher levels of T-tau, P-taul 81 t, P-tau 231 t, P-tau396s and P-tan199s and lower level of Aβ1-42 in CSF than those in the control group. PIGD group had significantly higher level of P-taul81t and lower level of Aβ1-42 than the TD group. （3） In univariate regression analysis, the score of PIGD in the PD patients was positively correlated with P-taul81t level in CSF, Hoehn-Yahr stage, the scores of anxiety, depression, fatigue and apathy, and negatively correlated with MoCA score and A[3142 level in CSF. In multiple regression analysis, the score of PIGD in PD patients was positively correlated with P-tau181t level and Hoehn-Yahr stage, and negatively correla

关 键 词：帕金森病 姿势步态异常表型 震颤表型 认知障碍 

分 类 号：R742.5[医药卫生—神经病学与精神病学]