帕金森病伴发抑郁的神经生化机制及白质纤维的变化  

Potential neurochemical mechanisms and white matter alterations in Parkinson's disease patients with depression

作　　者：连腾宏 左丽君[2] 郭鹏[2] 扈杨 余舒扬[2] 余秋瑾 王瑞丹[1] 金朝[1] 刘丽[2] 赵慧[2] 李丽霞[2] 朴英善[2] 张巍[1,2,3,4,5,6] LIAN Tenghong;ZUO Lijun;GUO Peng;HU Yang;YU Shuyang;YU Qiujin;WANG Ruidan;JIN Zhao;LIU Li;ZHAO Hui;LI Lixia;PIAO Yingshan;ZHANG Wei(Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China;Department of Geriatrics,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China;China National Clinical Research Center for Neurological Diseases,Beijing 100050,China;Key Laboratory for Neurodegenerative Disorders of the Ministry of Education,Capital Medical University,Beijing 100069,China;Center of Parkinson s Disease,Beijing Institute for Brain Disorders,Beijing 100053,China;Beijing Key Laboratory on Parkinson Disease,Beijing 100053,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 [3]国家神经系统疾病临床医学研究中心,100050 [4]教育部神经退行性疾病重点实验室,100069 [5]北京市脑重大疾病研究院帕金森病研究所,100053 [6]北京市帕金森病重点实验室,100053

出　　处：《中国神经免疫学和神经病学杂志》2018年第5期311-315,共5页Chinese Journal of Neuroimmunology and Neurology

基　　金：国家自然科学基金资助项目(81571229;81071015;30770745);北京市自然科学基金重点项目(kz201610025030;41610047082032);首都临床特色应用研究资助项目(z12110700100000;z121107001012161)

摘　　要：目的探讨帕金森病(Parkinson disease,PD)伴发抑郁的神经生化机制及白质纤维变化。方法连续收集2015-10—2017-12就诊于北京天坛医院的72例PD患者,根据24项汉密尔顿抑郁量表评分(HAMD-24)将患者分为PD伴发抑郁(PD with depression,PD-D)组和PD不伴发抑郁(PD without depression,PD-ND)组。比较两组患者脑脊液多巴胺(dopamine,DA)、5-羟色胺(serotonin,5-HT)、去甲肾上腺素(epinephrine,NE)水平及弥散张量成像-回波平面成像序列中各向异性分数(fractional anisotrophy,FA)的差异,并分析PD患者脑组织FA值与HAMD评分和脑脊液DA、5-HT、NE的相关性。结果与PD-ND组相比,PD-D组脑脊液DA、5-HT水平下降(均P<0.05),其中脑脊液DA水平与HAMD评分呈负相关(r<-0.267,P<0.05)。(2)PD-D患者穹窿、双侧扣带回、双侧额-枕束上辐射的FA值较PD-ND患者明显下降(均P<0.05),并与HAMD评分呈负相关(均P<0.05),双侧扣带回及双侧额-枕束上辐射的FA值与脑脊液DA水平呈正相关(均P<0.05)。结论DA及5-HT可能参与PD-D的发生,其中DA可能发挥更大的作用;PD-D患者穹窿、双侧扣带回及双侧额-枕束上辐射的白质纤维束受损更重,并与PD-D相关;双侧扣带回及额-枕束上辐射的破坏可能涉及DA能投射纤维,从而与PD-D相关。Objective To investigate neurochemical mechanisms and white matter alterations in Parkinson s disease(PD)patients with depression.Methods (1)72 PD patients were recruited from Beijing Tiantan Hospital,Capital Medical University.PD patients with Hamilton Depression Scale(HAMD)score≥8 or<8 points were divided into PD-D group and PD with no depression(PD-ND)group.(2)The levels of neurotransmitters,including dopamine(DA),serotonin(5-HT),and epinephrine(NE)in CSF in PD patients were measured.Correlations between the levels of neurotransmitters in CSF and the scores of HAMD were analyzed.(3)The subjects were scanned by generic sequences and diffusion tensor imaging-echo planar imaging(DTI-EPI)sequence.Fractional anisotropy(FA)values were compared between PD-D and PD-ND groups.Correlation analyses were made among FA values and the levels of neurotransmitters as well as HAMD scores in PD patients.Results The PD-D group had significantly reduced levels of DA and 5-HT in CSF compared with the PD-ND group(P<0.05).The score of HAMD had a significant negative correlation with DA level in CSF(r<-0.267,P<0.05).The PD-D group had reduced FA values of fornix,both sides of cingulum and superior fronto-occipital fasciculus than the PD-ND group(P<0.05).The score of HAMD had significant negative correlations with the FA values of fornix,both sides of cingulum and superior fronto-occipital fasciculus(P<0.05).The FA values of both sides of cingulum and frontal fasciculus had significant negative correlations with DA level in CSF(P<0.05).Conclusions DA and 5-HT are involved in the pathogenesis of PD-D,and DA may play a more important role.The fornix,both sides of cingulum and superior fronto-occipital fasciculus are more severely damaged in PD-D patients than in PD-ND patients,which may be related to PD-D.The destruction of both sides of cingulum and superior fronto-occipital fasciculus may damage the project pathway of DA,leading to PD-D.

关 键 词：帕金森病 抑郁 神经递质 弥散张量成像 多巴胺 血清素 去甲肾上腺素 

分 类 号：R742.5[医药卫生—神经病学与精神病学]