帕金森病患者的低铜蓝蛋白血症与黑质异常铁沉积的相关性  

The study on the association between hypoceruloplasminemia and abnormal iron deposition in substantia nigra in patients with Parkinson disease

作　　者：丛日博 贺娟[1] CONG Ribo;HE Juan(Department of Neurology,the Affiliated Hospital of Inner Mongolia Medical University,Huhehaote 010000)

机构地区：[1]内蒙古医科大学附属医院,呼和浩特010000

出　　处：《中国神经精神疾病杂志》2018年第6期331-336,共6页Chinese Journal of Nervous and Mental Diseases

基　　金：内蒙古自治区自然科学基金面上项目(编号:2014MS08105)

摘　　要：目的探讨帕金森病患者的低铜蓝蛋白血症与黑质异常铁沉积的相关性,为帕金森病的早期诊断及临床干预提供依据。方法选取原发性帕金森病患者55例作为PD组,其中血浆铜蓝蛋白浓度正常的帕金森病患者25例(PD1组),血浆铜蓝蛋白浓度低于正常的帕金森病患者30例(PD2组),同时选取与PD组年龄、性别相匹配的对照组25例,以上研究对象经磁敏感加权成像扫描后测量双侧黑质、红核、苍白球、尾状核、壳核、丘脑、前脑白质的相位值,并取双侧脑区相位值的平均值为相应脑区的相位值。各脑区的相位值进行比较,将PD2组的相位值与铜蓝蛋白的水平、帕金森病统一评分量表第三部分(UPDRS-Ⅲ)评分、Hoehn-Yahr分级、病程进行相关性分析。结果 PD组黑质相位值比对照组相位值低,差异有统计学意义(P<0.05),而PD组与对照组的其他脑区相位值比较无统计学意义(P>0.05);PD2组黑质的相位值比PD1组、对照组的黑质相位值低,差异有统计学意义(P<0.05),而PD1组与对照组的黑质相位值比较无统计学差异(P>0.05);PD2组UPDRS-Ⅲ评分与黑质相位值呈负相关(r=-0.765,P<0.001),铜蓝蛋白水平与黑质相位值呈正相关(r=0.675,P<0.001),而PD2组的Hoehn-Yahr分级、病程长短与黑质相位值无显著相关性。结论铜蓝蛋白水平低的帕金森病患者黑质相位值更低,这说明铁沉积更严重,血浆铜蓝蛋白的减少可能加剧了黑质的铁沉积,测量铁沉积的磁敏感加权成像与血浆铜蓝蛋白的测定相结合将有助于帕金森病的早期诊断、评估及治疗。Objective The deposition of iron in substantia nigra is the pathological change of Parkinson disease(PD).The aim of present study was to explore the related pathogenesis and risk factors of abnormal iron deposition to provide evidence for early diagnosis and clinical intervention of Parkinson disease(PD).Methods Fifty-five cases of PD were recruited from the Inner Mongolia Medical University Affiliated Hospital between September 2015 to December 2017,including 25 cases of normal ceruloplasmin in patients with PD(PD1),30 cases of hypoceruloplasminemia in patients with PD(PD2),and 25 age-,gender-matched healthy subjects served as controls,Susceptibility weighted imaging(SWI)was used to measure and calculate CP values of bilateral substantia nigra,red nucleus,globus pallidus,caudate nucleus,putamen,thalamus,frontal white matter.The CP values were compared among different brain regions and the correlation of the CP values with ceruloplasmin levels,UPDRS-Ⅲscore and Hoehn-Yahr grade,duration was analyzed.Results The phase values in the substantia nigra and red nucleus were lower in the case than in the control groups(P<0.05),The phase value in the substantia nigra was much lower in PD2 group than in the PD1 group and in the control group(P<0.05).The phase value of the red nucleus was significantly different between PD2 group and PD1 group(P>0.05).In PD2 group,CP value in substantia nigra was negatively associated with UPDRS-Ⅲscore(r=-0.765,P<0.001)and positively associated with ceruloplasmin levels(r=0.675,P<0.001).However,there were no significant correlations between Hoehn-Yahr grading,duration and the phase values in substantia nigra.Conclusion PD patients with hypoceruloplasminemia have low phase value in substantia nigra,indicating a more severe iron deposition which may be exacerbated by ceruloplasmin reduction.The low phase value in red nucleus in PD suggests that the role of red nucleus in the pathogenesis of PD cannot be ignored.A combination of SWI and ceruloplasmin is helpful for early diagnosis,evalu

关 键 词：帕金森病 铜蓝蛋白 磁敏感加权成像 黑质 

分 类 号：R742.5[医药卫生—神经病学与精神病学]