早期帕金森病伴认知功能障碍患者视网膜的形态及临床意义  

Clinical significance of change on retinal morphology in Parkinson’s disease patients with cognitive impairment at early stage

作　　者：杨紫姣 张金茹[2] 毛成洁[2] 魏静[3] 季晓燕[3] 刘春风[2] YANG Zi-jiao;ZHANG Jin-ru;MAO Cheng-jie;WEI Jing;JI Xiao-yan;LIU Chun-feng(Dept.of Geriatrics,Yangpu Hospital,Tongji University School of Medcine,Shanghai 200090,China;Det.of Neurology,Second Affiliated Hospital of Soochow University,Suzhou 215004,Jiangsu Province,China;Dept.of Ophthalmology,Second Affiliated Hospital of Soochow University,Suzhou 215004,Jiangsu Province,China)

机构地区：[1]同济大学附属杨浦医院老年科,上海200090 [2]苏州大学附属第二医院神经内科,江苏苏州215004 [3]苏州大学附属第二医院眼科,江苏苏州215004

出　　处：《同济大学学报（医学版）》2020年第2期245-250,共6页Journal of Tongji University(Medical Science)

基　　金：江苏省临床医学科技专项(BL2014042);上海市杨浦区中心医院院级课题(Sel201907)。

摘　　要：目的探讨早期帕金森病(Parkinson’s disease, PD)伴认知功能障碍患者视网膜形态的改变及其与临床特征之间可能存在的关系。方法收集神经内科就诊的PD患者共53例(106只眼)以及同期健康体检的正常人20例(40只眼),对PD患者进行统一PD评定量表运动检查(UPDRS-Ⅲ)评分、简易认知评估量表(MMSE)、蒙特利尔认知评估量表(MOCA)、匹兹堡睡眠指数量表(PSQI)、Epworth嗜睡量表(ESS)评分。根据认知量表评估结果将患者分为PD认知正常组21例,PD认知障碍组32例。利用光学相干断层成像(optical coherence tomography, OCT)测定受试对象视盘周围上、下、鼻、颞象限及对应的12钟点象限视网膜纤维层(retinal nerve fiber layer, RNFL)厚度,以及黄斑区厚度、黄斑容积。结果 PD认知障碍组与认知正常组相比,H-Y分级更高(P=0.037)、ESS得分更高(P=0.014)。PD认知障碍组、PD认知正常组、健康对照组OCT视觉参数分析比较,视盘颞侧9:00钟方向RNFL厚度三组差异有统计学意义(P=0.020);亚组间比较,PD认知障碍组较认知正常组变薄(P=0.006)。三组黄斑区容积、黄斑中心凹厚度、平均厚度、外环厚度均有显著差异(P均<0.05);亚组间比较,PD认知障碍组较认知正常组黄斑中心凹厚度均显著变薄;进一步进行相关分析,PD患者中MOCA得分(r=0.317)、定向力分数(r=0.416)与黄斑中心凹厚度呈正相关。结论病情严重程度、嗜睡的发生情况是PD发生认知障碍的主要影响因素,而且PD伴认知功能障碍患者存在视网膜纤维层和黄斑区结构的异常,特别是MOCA得分越低、定向力得分越差的患者,黄斑中心凹厚度越薄。Objective To explore the relationship between the change of retinal morphology and clinical characteristics in Parkinson’s disease(PD) patients with cognitive impairment at early stage. Methods Fifty-three PD patients at early stage(106 eyes) and 20 healthy controls(40 eyes) were enrolled. According to the evaluation results of MMSE and MOCA, there were 21 patients with normal cognitive patients(42 eyes) and 32 with cognitive impairment patients(64 eyes) among 53 PD patients. Optical coherence tomography(OCT) was used to measure the fiber layer thickness, macular area thickness and macular volume in the upper, lower, nasal, temporal quadrants and corresponding 12-hour quadrants around the optic disc of PD patients. Results PD patients with cognitive impairment had more severity of disease(P=0.037), and higher score of ESS(P=0.014). Compared with healthy controls and PD patients with normal cognition, the thickness of temporal side around optic disc at 9: 00 clock in PD patients with cognitive impairment was significantly thinning(58.76±10.57μm vs. 54.58±9.02μm, 58.76±10.57μm vs. 53.33±9.82μm, P=0.02 and P=0.006). There were significant differences in the macular volume, the thickness of macular fovea, average thickness, macular outering thickness among three groups(all P<0.05). Moreover, the score of MOCA(r=0.317) and the score of directive force(r=0.416) was negatively association with thickness of macular fovea. Conclusion Parkinson’s disease patients with cognitive impairment have structural abnormalities in retinal nerve fiber layer and macular area compared with normal cognitive patients and healthy controls.

关 键 词：帕金森病 光学相干断层成像 认知障碍 视网膜神经纤维厚度 黄斑区 

分 类 号：R743[医药卫生—神经病学与精神病学]