增龄相关脑白质高信号与帕金森病脑萎缩及认知障碍的相关性  

Association of age-related white matter hyperintensity with brain atrophy and cognitive impairment in patients with Parkinson′s disease

作　　者：陈慧敏[1] 张美美 王伊龙[1] Chen Huimin;Zhang Meimei;Wang Yilong(Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,China National Clinical Research Center for Neurological Diseases(NCRC-ND),Advanced Innovation Center for Human Brain Projection,Beijing 100070,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国家神经系统疾病临床医学研究中心北京脑重大疾病研究院脑卒中研究所,北京100070

出　　处：《中华医学杂志》2020年第43期3397-3401,共5页National Medical Journal of China

基　　金：国家自然科学基金委员会杰出青年科学基金(81825007);科技部"十三五"国家重点研发计划(2017YFC1307900);北京高校卓越青年科学家计划(BJJWZYJH01201910025030)。

摘　　要：目的:观察增龄相关脑白质高信号(WMH)与帕金森病(PD)脑萎缩、认知障碍之间的关系。方法:回顾性分析2018年10月至2019年8月就诊于首都医科大学附属北京天坛医院运动障碍性疾病科且行三维磁共振结构成像的原发性PD患者连续样本。患者认知功能采用简易精神状态量表(MMSE)与蒙特利尔认知评估量表(MoCA)评估。WMH严重程度采用Fazekas半定量量表(0~6分);通过FreeSurfer自动化定量分析全脑皮质平均厚度、双侧丘脑平均体积。首先,组间比较PD伴痴呆与不伴痴呆患者人口学及疾病特点、WMH严重程度、全脑皮质平均厚度、丘脑体积。其次,采用单因素和多因素广义线性模型分析WMH严重程度、脑萎缩、MoCA之间的关系。结果:本研究共纳入225例原发性PD患者,患者中位年龄66岁。组间比较提示,与PD不伴痴呆组相比,PD伴痴呆组WMH更加严重、年龄较大、血清胆固醇和低密度脂蛋白水平较低、全脑皮质平均厚度较小(均P<0.05),但丘脑体积组间差异无统计学意义。广义线性模型提示,PD患者MoCA评分独立于全脑皮质平均厚度、年龄、血清胆固醇及低密度脂蛋白,与WMH Fazekas评分显著相关(回归系数β=-0.021,95%CI:-0.040^-0.002,P=0.032)。结论:WMH独立于脑萎缩加重PD认知障碍。有效防治脑小血管病对PD认知功能可能具有保护作用。Objective To investigate the association of age-related white matter hyperintensity(WMH)with brain atrophy and cognitive impairment in patients with Parkinson's disease(PD).Methods Consecutive samples of a prospective PD cohort with complete 3-dimensional magnetic resonance imaging in the Department of Movement Disorders in Beijing Tiantan Hospital,Capital Medical University,from October 2018 to August 2019 was retrospectively analyzed.Cognition was evaluated by Mini-Mental State Scale(MMSE)and Montreal Cognitive Assessment(MoCA).The severity of WMH was semi-quantitatively measured by Fazekas scale(0-6 points),and the mean cortical thickness and thalamus volume were calculated by FreeSurfer software.The demographic and disease characteristics,the severity of WMH,the mean cortical thickness and thalamus volume were respectively compared between PD patients with and without dementia.Moreover,univariate and multivariate generalized linear models were used to analyze the correlation of the severity of WMH with brain atrophy and MoCA.Results A total of 225 patients with PD were included in the study,with a median age of 66 years old.Comparisons between groups suggested that patients with dementia were with severer WMH,older,and had lower levels of serum cholesterol and low-density lipoprotein and more reduced mean cortical thickness than those without dementia(all P<0.05),but no significant difference in the thalamus volume was found between the two groups.The generalized linear model showed that the cognitive impairment of PD patients was significantly correlated with WMH(β=-0.021,95%CI:-0.040--0.002,P=0.032),but independent of age,cortical thickness,and levels of serum cholesterol and low-density lipoprotein.Conclusion WMH may worsen PD cognitive impairment independent of brain atrophy.Clinical prevention and treatment of cerebral small vessel disease may have protective effects on cognitive function in patients with PD.

关 键 词：脑小血管病 白质高信号 脑萎缩 帕金森病 认知障碍 

分 类 号：R742.5[医药卫生—神经病学与精神病学]