不同临床亚表型帕金森病的经颅超声黑质影像学检查及其与铁代谢的相关性研究  

Transcranial sonography image characteristics of substantia nigra in different Parkinson′s disease subtypes and their correlation with iron metabolism

作　　者：应晨楚 张迎春[1] 丁常伟 王才善[1] 盛余敬[1] 陈晓芳[1] 张英[1] 杨敏 毛攀 杨勇[2] 冯萍[2] 毛成洁[3] 陈静[3] 刘春风[3] Ying Chenchu;Zhang Yingchun;Ding Changwei;Wang Caishan;Sheng Yujing;Chen Xiaofang;Zhang Ying;Yang Min;Mao Pan;Yang Yong;Feng Ping;Mao Chengjie;Chen Jing;Liu Chunfeng(Department of Ultrasound,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Laboratory,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Neurology and Clinical Research Center of Neurological Disease,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]苏州大学附属第二医院超声科,苏州215004 [2]苏州大学附属第二医院检验科,苏州215004 [3]苏州大学附属第二医院神经内科和神经疾病临床研究中心,苏州215004

出　　处：《中华超声影像学杂志》2023年第4期332-338,共7页Chinese Journal of Ultrasonography

基　　金：苏州大学附属第二医院学科建设托举工程(XKTJ-TD202007);老年医学临床技术应用研究项目单位(LD2021031)。

摘　　要：目的通过分析姿势步态异常型与震颤型帕金森病(PD)患者的经颅超声检查(TCS)黑质(SN)区回声特征、血清铁代谢参数及二者相关性,以探索SN回声变化的病理机制。方法回顾性纳入2019年1月至2021年12月在苏州大学附属第二医院帕金森病专科就诊的155例PD患者,其中95例姿势步态异常型(姿势步态异常组),60例震颤型(震颤组);选取同期性别和年龄相匹配的健康体检者49例作为对照组。对所有受检者进行TCS检查和血清铁代谢参数检测,比较分析两组PD患者SN区回声变化特点及三组间铁代谢参数的差异;根据TCS结果分别将姿势步态异常组和震颤组细分为SN强回声阳性(SN+)亚组与SN强回声阴性(SN-)亚组,比较各亚组间铁代谢参数的差异。分析姿势步态异常组和震颤组SN强回声与铁代谢参数的相关性。结果姿势步态异常组双侧SN强回声总面积、较大一侧SN强回声面积及SN强回声总面积与中脑面积的比值(S/M)大于震颤组(均P<0.01)。姿势步态异常组和震颤组血清铜蓝蛋白和转铁蛋白低于对照组(均P<0.001);姿势步态异常组血清铁蛋白低于震颤组和对照组(均P<0.01)。姿势步态异常组和震颤组中,SN+亚组血清铜蓝蛋白均低于SN-亚组(P=0.001,0.032),且SN的强回声总面积与转铁蛋白水平呈负相关(姿势步态异常组:rs=-0.494,P<0.001;震颤组:r_(s)=-0.461,P<0.001)。结论相较于震颤型PD患者,姿势步态异常型患者的SN强回声明显、血清铁蛋白水平较低;SN强回声面积与血清转铁蛋白水平呈负相关,提示该影像学征象的产生与铁代谢存在一定相关性。Objective To explore the pathological mechanism of SN hyperechogenicity by investigating the characteristics of substantia nigra(SN)hyperechogenicity on transcranial sonography(TCS)and serum iron metabolism parameters in the postural instability gait difficulty and tremor dominant subtypes of Parkinson′s disease(PD),and the correlation between them.Methods A total of 155 PD patients recruited in Parkinson′s Disease Specialty in the Second Affiliated Hospital of Soochow University from January 2019 to December 2021 were divided into postural instability gait difficulty group(n=95)and tremor dominant group(n=60).Meanwhile,49 healthy gender-and age-matched healthy individuals who sought for physical examination during the same period were included as the control group.All subjects underwent TCS and blood test,and the echo of SN between the postural instability gait difficulty group and tremor dominant group,serum iron metabolism parameters among the three groups were compared.The postural instability gait difficulty group and tremor dominant group were subdivided into with SN hyperechogenicity(SN+)subgroup and without SN hyperechogenicity(SN-)subgroup respectively according to TCS results,and the differences in serum iron metabolism parameters between the subgroups were further compared.The association between SN hyperechogenicity and serum iron metabolism parameters of the postural instability gait difficulty group and tremor dominant group were further analyzed.Results The total area of bilateral SN+,the area of SN+on the larger side,and the ratio of the total area of SN+to the midbrain area(S/M)in postural instability gait difficulty group were larger than those in tremor dominant group(all P<0.001).The value of serum ceruloplasmin and transferrin in both postural instability gait difficulty group and tremor dominant group were lower than those in control group(all P<0.001),and compared with tremor dominant group and control group,the postural instability gait difficulty group had lower serum ferritin(all P<0

关 键 词：超声检查 经颅 帕金森病 黑质 铁代谢 

分 类 号：R742.5[医药卫生—神经病学与精神病学]