不同运动障碍亚型帕金森病患者脑灰质核团微观结构的扩散峰度成像特征  

Diffusion kurtosis imaging characteristics of brain gray matter nucleus microstructure in Parkinson's disease with different movement disorder subtypes

作　　者：王波[1] 马莎[2] 龚霞蓉[1] 张洁[1] 任丽香[1] 陈渝晖[1] 安鸿飞[1] 罗跃嘉[3,4] Wang Bo;Ma Sha;Gong Xiarong;Zhang Jie;Ren Lixiang;Chen Yuhui;An Hongfei;Luo Yuejia(Department of Magnetic Resonane,the First People's Hospital of Yunnan Province(Medical Faculty of Kunming University of Science and Technology),Kunming 650032,China;Department of Neurology,the First People's Hospital of Yunnan Province(Medical Faculty of Kunming University of Science and Technology),Kunming 650032,China;The Center of Brain Disease and Cognitive Science,Shenzhen University,Shenzhen 518060,China;The Research Center of Brain Science and Visual Cognition,Kunming University of Science and Technology,Kunming 650504,China)

机构地区：[1]云南省第一人民医院(昆明理工大学附属医院)磁共振科,650032 [2]云南省第一人民医院(昆明理工大学附属医院)神经内科,650032 [3]深圳大学脑疾病与认知科学研究中心,518060 [4]昆明理工大学脑科学与视觉认知研究中心,650504

出　　处：《中华行为医学与脑科学杂志》2019年第10期875-880,共6页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：云南省应用基础研究(昆医联合专项)项目(2017FE468(-128),2017FE467(-123))。

摘　　要：目的 探讨扩散峰度成像(diffusion kurtosis imaging,DKI)各参数值在不同运动障碍亚型帕金森病(Parkinson's disease,PD)患者及正常对照组灰质核团的变化及不同运动障碍亚型临床异质性表现.方法 对97例PD患者及83例正常对照组进行常规序列及DKI序列检查. PD患者根据运动症状分为两型:姿势步态异常型( postural instability and gait disorder,PIGD;n=57例)及震颤型(tremor dominant,TD;n=40例).经图像后处理生成各向异性分数( FA)图、平均弥散率( MD)图 、横向弥散率(Da)图、径向弥散率(Dr)图、平均弥散峰度(MK)图、横向峰度( Ka)图和径向峰度( Kr)图,分别测量左、右侧红核、黑质网状带、黑质致密带、尾状核头、壳核、苍白球和丘脑的各参数值,并对所得数据进行统计分析.结果 (1)TD型PD患者的首发症状以震颤为主;而PIGD型PD患者的首发症状以强直、运动迟缓及步态障碍为主;TD型的MMSE评分较PIGD型高(P=0. 019);且改良Hoehn-Yahr病情分级较轻(P<0. 001);这两型PD在发病年龄、性别构成、起病侧、病程等方面对比差异无统计学意义(均P>0. 05). (2)与正常对照组对比,①PIGD型及TD型各核团MD值、Da值及Dr值均明显降低,而Ka值升高,均差异有统计学意义(均 P<0. 001);②PIGD 型黑质网状带 MK 值( 0. 80± 0. 18)、TD型黑质网状带、黑质致密带、壳核和苍白球 MK值( 0. 83± 0. 26,0. 84 ± 0. 20,0. 75± 0. 07, 0. 81±0. 14)升高,差异有统计学意义(P=0. 017,P=0. 010,P=0. 020,P<0. 001,P=0. 002);③PIGD型壳核、尾状核头Kr值(0. 71±0. 17,0. 72±0. 14)、TD型尾状核头Kr值(0. 70±0. 14)降低,差异有统计学意义(P=0. 002,P=0. 031,P=0. 007). (3) TD型与PIGD型比较壳核的MK值差异有统计学意义(t=-2. 214,P=0. 029),余核团的参数值差异无统计学意义(P>0. 05). (4)PIGD型和TD型各灰质核团的各参数值与病程、MMSE评分及改良Hoehn-Yahr病情分级之间均无相关性(P>0. 05).结论 TD型与PIGD型PD在首发�Objective To investigate the difference in the microstructure of gray matter nucleus in different movement subtypes of Parkinson’s disease (PD) by diffusion kurtosis imaging ( DKI) technique, and to analyze the correlation with clinical manifestations. Methods Ninety-seven patients with PD and 83 healthy controls performed conventional MRI sequence and DKI sequence scan. The PD patients were classi-fied into gait disorder subtype (PIGD,n=57) and tremor dominant subtype (TD,n=40)subtypes according to motor symptoms. Fractional anisotropy (FA),mean diffusivity (MD),axial diffusivity (Da),radial diffu-sivity(Dr),mean kurtosis (MK),axial kurtosis (Ka) and radial kurtosis (Dr) maps and data were genera-ted by software after processing. DKI was performed for all subjects and data was collected from different brain regions in both hemispheres,including red nucleus(RN),substantia nigra pars reticulate( SNr),sub-stantia nigra pars compacta(SNc),putamen(PUT),globus pallidus(GP),head of caudate nucleus (CN)and thalamus(THA). Results TD showed a higher MMSE score(P=0. 019),but lower modified Hoehn-Yahr score than that in PIGD (P<0. 001),there was no significant difference of age of onset,sex,limbs of onset or disease duration between two PD subgroups. Compared with healthy controls, both TD and PIGD showed down-regulated MD,Da and Dr and up-regulated Ka values(P<0. 001);MK(0. 83±0. 26,0. 80±0. 18) was increased in SNr both in TD and PIGD,while SNc,PUT and GP (0. 84± 0. 20,0. 75± 0. 07,0. 81± 0. 14) were decreased only in TD (P=0. 017,P=0. 010,P=0. 020,P<0. 001,P=0. 002). The Kr values of PUT and CN(0. 71±0. 17,0. 72±0. 14) were reduced in PIGD,while CN(0. 70±0. 14) were reduced in TD re-spectively (P=0. 002,P=0. 031,P=0. 007). The MK was lower in TD than that in PIGD (t=-2. 214,P=0. 029),and no significant difference was found in other grey matter nuclei between TD and PIGD ( P>0. 05). Moreover,there was no significant correlation between DKI value and disease duration,MMSE score or Hoehn-Yahr scale (P>0. 05) in TD

关 键 词：帕金森病 运动障碍亚型 扩散峰度成像 异质性 

分 类 号：R74[医药卫生—神经病学与精神病学]